Efficacy of Preoperative Propranolol in Preventing Junctional Ectopic Tachycardia after Complete Repair of Tetralogy of Fallot

Abstract

Abstract

Background and Objective:  Junctional ectopic tachycardia (JET) is a common arrhythmia causing hemodynamic impairment following tetralogy of Fallot (TOF) complete repair. Although propranolol is used in these patients to prevent and control hypercyanotic spells, its antiarrhythmic effects are not widely studied in the postoperative period. We undertook this study to examine possible preventive effects of propranolol on postoperative JET after complete surgical repair of TOF.

Materials and Methods: This is a prospective study conducted in the pediatric cardiac intensive care unit (PCICU) at University Children's Hospital, and was carried out on 124 patients who had complete repair of tetralogy of Fallot. Patients were classified into two groups: the propranolol group (71patients) who received propranolol preoperatively, and the control group (53 patients) who did not receive propranolol preoperatively.

Results: Incidence of cyanotic spells was higher in the propranolol group compared to the control group (p value=0.005). The overall incidence of JET in our study was 16.9%, where the incidence of postoperative JET was 8.5% in the propranolol group and 28.3% in the control group (P value=0.004). High inotropic requirements were lower in the propranolol group (p value=0.028). The mortality rate was higher in JET patients (10 deaths in JET patients 47.6% vs. 10 deaths in the other patients 9.7%) which was a statistically significant difference (P value=0.0001).

Conclusions: Prophylactic use of propranolol is associated with a significantly decreased incidence of postoperative junctional ectopic tachycardia in children after complete surgical repair of TOF.