Junctional Ectopic Tachycardia Medication
- Author: M Silvana Horenstein, MD; Chief Editor: Stuart Berger, MD more...
The mechanism of junctional ectopic tachycardia (JET) is not well understood, and identifying a specific pharmacologic agent to target the disorder is difficult. Because some experimental forms of junctional tachycardia exhibit a triggered mechanism induced by digoxin toxicity, avoiding digoxin seems reasonable. Nevertheless, digoxin is frequently used in the treatment of JET without apparent adverse effect but with questionable efficacy. Ventricular dysfunction is often prominent in patients with postoperative and congenital JET; thus, calcium channel blockers are usually avoided because of their negative inotropic effects. One case report has documented use of calcium channel blockers with apparent effectiveness. Drugs effective against automatic tachycardias appear to be effective in the treatment of congenital and postoperative JET.
Congenital JET has been successfully controlled with amiodarone, propafenone, or cautious combinations of both medications. Postoperative JET has been successfully controlled with amiodarone, propafenone, procainamide, or moricizine (discontinued from the market in July 2007). Propranolol or sotalol have also been used in the therapy of these rhythm disorders.
These agents alter the electrophysiologic mechanisms responsible for arrhythmia.
May inhibit AV conduction and sinus node function. Prolongs action potential and refractory period in myocardium and inhibits adrenergic stimulation.
Before administration, control the ventricular rate and CHF (if present) with digoxin.
Treats life-threatening arrhythmias. Possibly works by reducing spontaneous automaticity and prolonging refractory period.
Discontinued in July 2007 because of diminished market demand. Class I antiarrhythmic agent. Significantly prolongs conduction within the atrium, AV node, and ventricular myocardium without affecting their refractory periods. No direct effect on sinus node function.
Class IA antiarrhythmic used for PVCs, ventricular tachycardias, and supraventricular tachycardias. Increases refractory period of the atria and ventricles. Myocardiac excitability is reduced by an increase in threshold for excitation and inhibition of ectopic pacemaker activity.
Class II antiarrhythmic nonselective beta-adrenergic receptor blocker with membrane-stabilizing activity that decreases automaticity of contractions.
Class III antiarrhythmic agent, which blocks potassium channels, prolongs action potential duration (APD), and lengthens QT interval. Noncardiac selective beta-adrenergic blocker.
Selectively blocks beta1-receptors with little or no effect on beta2 types.
Dodge-Khatami A, Miller OI, Anderson RH, et al. Surgical substrates of postoperative junctional ectopic tachycardia in congenital heart defects. J Thorac Cardiovasc Surg. 2002 Apr. 123(4):624-30. [Medline].
Zampi JD, Hirsch JC, Gurney JG, Donohue JE, Yu S, LaPage MJ, et al. Junctional ectopic tachycardia after infant heart surgery: incidence and outcomes. Pediatr Cardiol. 2012 Dec. 33(8):1362-9. [Medline].
Liu CF, Ip JE, Lin AC, Lerman BB. Mechanistic Heterogeneity of Junctional Ectopic Tachycardia in Adults. Pacing Clin Electrophysiol. 2011 Sep 28. [Medline].
Hoffman TM, Bush DM, Wernovsky G, et al. Postoperative junctional ectopic tachycardia in children: incidence, risk factors, and treatment. Ann Thorac Surg. 2002 Nov. 74(5):1607-11. [Medline].
Andreasen JB, Johnsen SP, Ravn HB. Junctional ectopic tachycardia after surgery for congenital heart disease in children. Intensive Care Med. 2008 May. 34(5):895-902. [Medline].
Zhao H, Cuneo BF, Strasburger JF, Huhta JC, Gotteiner NL, Wakai RT. Electrophysiological characteristics of fetal atrioventricular block. J Am Coll Cardiol. 2008 Jan 1. 51(1):77-84. [Medline].
Borgman KY, Smith AH, Owen JP, Fish FA, Kannankeril PJ. A genetic contribution to risk for postoperative junctional ectopic tachycardia in children undergoing surgery for congenital heart disease. Heart Rhythm. 2011 Dec. 8(12):1900-4. [Medline]. [Full Text].
Imamura M, Dossey AM, Garcia X, Shinkawa T, Jaquiss RD. Prophylactic amiodarone reduces junctional ectopic tachycardia after tetralogy of Fallot repair. J Thorac Cardiovasc Surg. 2011 Oct 27. [Medline].
Saul JP, Scott WA, Brown S, et al. Intravenous amiodarone for incessant tachyarrhythmias in children: a randomized, double-blind, antiarrhythmic drug trial. Circulation. 2005 Nov 29. 112(22):3470-7. [Medline].
Imamura M, Dossey AM, Garcia X, Shinkawa T, Jaquiss RD. Prophylactic amiodarone reduces junctional ectopic tachycardia after tetralogy of Fallot repair. J Thorac Cardiovasc Surg. 2012 Jan. 143(1):152-6. [Medline].
Guccione P, Di Carlo D, Papa M, et al. [Hypothermia treatment of junctional ectopic tachycardia after surgical repair of congenital heart defects]. G Ital Cardiol. 1990 May. 20(5):415-8. [Medline].
Pfammatter JP, Paul T, Ziemer G, Kallfelz HC. Successful management of junctional tachycardia by hypothermia after cardiac operations in infants. Ann Thorac Surg. 1995 Sep. 60(3):556-60. [Medline].
Walsh EP, Saul JP, Sholler GF, et al. Evaluation of a staged treatment protocol for rapid automatic junctional tachycardia after operation for congenital heart disease. J Am Coll Cardiol. 1997 Apr. 29(5):1046-53. [Medline].
Wu MH, Lin JL, Chang YC. Catheter ablation of junctional ectopic tachycardia by guarded low dose radiofrequency energy application. Pacing Clin Electrophysiol. 1996 Nov. 19(11 Pt 1):1655-8. [Medline].
Manrique AM, Arroyo M, Lin Y, El Khoudary SR, Colvin E, Lichtenstein S, et al. Magnesium supplementation during cardiopulmonary bypass to prevent junctional ectopic tachycardia after pediatric cardiac surgery: a randomized controlled study. J Thorac Cardiovasc Surg. 2010 Jan. 139(1):162-169.e2. [Medline].
Emmel M, Sreeram N, Brockmeier K. Catheter ablation of junctional ectopic tachycardia in children, with preservation of atrioventricular conduction. Z Kardiol. 2005 Apr. 94(4):280-6. [Medline].