Effectiveness of R-wave synchronized atrial pacing for refractory junctional ectopic tachycardia with circulatory insufficiency after pediatric cardiac surgery: a case report

Abstract

Junctional ectopic tachycardia (JET) after pediatric heart surgery is often difficult to treat. A 2-month-old boy underwent total anomalous pulmonary venous return repair and pulmonary artery banding for asplenia and total anomalous pulmonary venous return. JET appeared after surgery, and antiarrhythmic drugs (amiodarone and landiolol) were administered in the operating room. In the PICU, in addition to the antiarrhythmic drugs, sedation management, electrolyte correction, body temperature control, catecholamine adjustment, and overpacing by atrial pacing were also performed. However, as the JET rate increased, management became difficult, and his hemodynamics deteriorated. By switching to R-wave synchronized atrial pacing, atrioventricular synchronization could be obtained without an increase in heart rate, and further deterioration of hemodynamics was prevented. Although this pacing mode has been used in Europe and the United States, it is not generally used in Japan. Therefore, R-wave synchronized atrial pacing is considered as one of the pacing mode options in the management of refractory JET.