# Incidence, Risk Factors and Outcomes of Junctional Ectopic Tachycardia After Tetralogy of Fallot Repair in Pediatric Patients

## TL;DR

This study finds that 16.7% of children develop junctional ectopic tachycardia after tetralogy of Fallot repair, with specific risk factors and outcomes identified.

## Contribution

The study identifies right ventricular outflow tract muscle resection, low ionized calcium, and high vasoactive-inotropic scores as novel independent risk factors for JET.

## Key findings

- JET occurred in 16.7% of children after tetralogy of Fallot repair.
- JET patients had higher complication rates and increased mortality compared to those without JET.

## Abstract

What are the main findings?
Junctional ectopic tachycardia (JET) occurred in 16.7% of children after tetralogy of Fallot repair.Right ventricular outflow tract muscle resection, low ionized calcium, and higher vasoactive-inotropic scores were identified as independent risk factors for JET.

Junctional ectopic tachycardia (JET) occurred in 16.7% of children after tetralogy of Fallot repair.

Right ventricular outflow tract muscle resection, low ionized calcium, and higher vasoactive-inotropic scores were identified as independent risk factors for JET.

What is the implication of the main finding?
Early identification of at-risk patients and optimization of perioperative electrolyte balance and hemodynamic management may reduce JET incidence and complications.Understanding modifiable surgical and metabolic risk factors can improve postoperative outcomes and survival in pediatric congenital heart surgery.

Early identification of at-risk patients and optimization of perioperative electrolyte balance and hemodynamic management may reduce JET incidence and complications.

Understanding modifiable surgical and metabolic risk factors can improve postoperative outcomes and survival in pediatric congenital heart surgery.

Background: Postoperative junctional ectopic tachycardia (JET) is a potentially life-threatening arrhythmia that may occur after congenital heart surgery, especially following tetralogy of Fallot (TOF) repair. It can cause hemodynamic instability due to atrioventricular dissociation. This study aimed to evaluate the incidence, risk factors, and outcomes of JET after TOF repair, with particular focus on management strategies and the impact of JET duration on recovery. Methods: This retrospective study included 114 pediatric patients who underwent TOF repair between 2015 and 2023. The study was approved by the institutional ethics committee (File No: 2023/09-31, Date: 10 October 2023). Postoperative JET was diagnosed based on standard electrocardiographic criteria. Perioperative variables, surgical techniques, and postoperative outcomes were analyzed. Results: JET occurred in 19 patients (16.7%). Compared with patients without JET, those with JET had higher complication rates (73.7% vs. 42.1%, p = 0.02), prolonged inotropic support, and increased mortality (15.8% vs. 2.1%, p = 0.024). Ionized calcium (p < 0.001) and pH levels (p < 0.037) were significantly lower in JET patients. Right ventricular outflow tract muscle resection was strongly associated with JET occurrence (p = 0.003). Although cardiopulmonary bypass and aortic cross-clamp times did not predict JET, both correlated with JET duration (p < 0.05). Conclusions: Postoperative JET remains a major concern following TOF repair, leading to adverse outcomes and longer recovery. Optimizing perioperative management may help reduce JET-related complications, though further multicenter prospective studies are needed to confirm these findings.