儿童先天性心脏病术后交界性异位心动过速临床特征和危险因素分析OA

Objective To analyze the clinical characteristics and related risk factors for junctional ectopic tachycardia(JET)after surgery for congenital heart disease(CHD)in children.Methods A retrospective analysis was conducted on 1057 children undergoing CHD repair surgery performed under cardiopulmonary bypass at the Cardiac Center of Beijing Children's Hospital,Capital Medical University from May 2023 to May 2025.Among them,32 cases developed postoperative JET(POJET).Two non-POJET children who underwent surgery by the same surgeon during the same period were selected as the control group to identify possible risk factors.Results The incidence of POJET in this study was 3.03%,among which 81.3%of the children were aged≤12 months;87.5%of the children weighed≤10 kg;75.0%of the children involved surgical operations in the ven-tricular septal area.During POJET episodes,both systolic blood pressure and mean arterial pressure were significantly lower than those during sinus rhythm(both P<0.001).90.6%of the children experienced POJET within 24 hours after surgery,and 75%of the children returned to sinus rhythm within 72 hours after surgery.100%of the children showed atrioventricular dissociation,among which 12.5%of the children intermittently presented with 1:1 atrioventricular retrograde conduction.Univariate analy-sis showed that younger age,lower weight,and higher vasoactive-inotropic score(VIS)were associated with an increased risk POJET.Multivariate analysis showed that higher VIS was associated with the occurrence of POJET.Compared with the control group,the mechanical ventilation(MV)time and cardiac intensive care unit(CCU)hospitalization time of children with POJET were prolonged.Among the 32 children who received general treatment,17 returned to sinus rhythm;5 children who received combined therapeutic hypothermia and 10 children who received combined antiarrhythmic drug treatment all returned to sinus rhythm.There were no cases of cardiopulmonary resuscitation,ECMO assistance,or death within 30 days after surgery.Con-clusion POJET occurs more frequently in younger children with lower body weight and those undergoing surgical procedures in the ventricular septal area.A high VIS score was an independent risk factor for POJET.Most cases of POJET occur within 24 hours after surgery and revert to sinus rhythm within 72 hours.The occurrence of POJET can deteriorate hemodynamics,prolong MV time and CCU hospital stay.Most children can successfully return to sinus rhythm after general treatment,and some required combined treatment with therapeutic hypothermia or antiarrhythmic drugs.The prognosis is good.