Clinical risk prediction score for postoperative accelerated junctional rhythm and junctional ectopic tachycardia in children with congenital heart disease

Heart Rhythm. 2023 Jul;20(7):1011-1017. doi: 10.1016/j.hrthm.2023.03.005. Epub 2023 Mar 8.

Abstract

Background: Accelerated junctional rhythm (AJR) and junctional ectopic tachycardia (JET) are common postoperative arrhythmias associated with morbidity/mortality. Studies suggest that pre- or intraoperative treatment may improve outcomes, but patient selection remains a challenge.

Objectives: The purpose of this study was to describe contemporary outcomes of postoperative AJR/JET and develop a risk prediction score to identify patients at highest risk.

Methods: This was a retrospective cohort study of children aged 0-18 years undergoing cardiac surgery (2011-2018). AJR was defined as usual complex tachycardia with ≥1:1 ventricular-atrial association and junctional rate >25th percentile of sinus rate for age but <170 bpm, whereas JET was defined as a rate >170 bpm. A risk prediction score was developed using random forest analysis and logistic regression.

Results: Among 6364 surgeries, AJR occurred in 215 (3.4%) and JET in 59 (0.9%). Age, heterotaxy syndrome, aortic cross-clamp time, ventricular septal defect closure, and atrioventricular canal repair were independent predictors of AJR/JET on multivariate analysis and included in the risk prediction score. The model accurately predicted the risk of AJR/JET with a C-index of 0.72 (95% confidence interval 0.70-0.75). Postoperative AJR and JET were associated with prolonged intensive care unit and hospital length of stay, but not with early mortality.

Conclusion: We describe a novel risk prediction score to estimate the risk of postoperative AJR/JET permitting early identification of at-risk patients who may benefit from prophylactic treatment.

Keywords: Arrhythmias; Junctional; Pediatric; Risk prediction; Tachycardia.

MeSH terms

  • Cardiac Surgical Procedures* / adverse effects
  • Child
  • Heart Defects, Congenital* / complications
  • Heart Defects, Congenital* / surgery
  • Humans
  • Infant
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Tachycardia / etiology
  • Tachycardia, Ectopic Junctional* / diagnosis
  • Tachycardia, Ectopic Junctional* / etiology
  • Tachycardia, Supraventricular* / etiology