Propranolol: a new indication for an old drug in preventing postoperative junctional ectopic tachycardia after surgical repair of tetralogy of Fallot.

Junctional ectopic tachycardia (JET) is a major cause of postoperative morbidity after complete repair of tetralogy of Fallot (TOF). Propranolol is a known medication used in patients with TOF to prevent and control hypercyanotic spells. Despite this, there is little information regarding the relation between preoperative use of propranolol and the incidence of postoperative JET. The aim of this study was to examine the effect of preoperative use of propranolol on the incidence of postoperative JET after full surgical repair of TOF. A retrospective analysis of 109 patients in whom 57 patients received preoperative propranolol (propranolol group) was compared with 52 patients who did not receive propranolol preoperatively (control group). The incidence of postoperative JET was significantly higher in the control group (38%) than the propranolol group (21%) P=0.042. The propranolol group had significantly less mechanical ventilation time, less ICU stay and less total hospital stay than the control group (P<0.05). Our findings suggest that the preoperative use of propranolol may decrease the incidence of JET after full surgical repair of TOF. A prospective randomized study may help to elucidate the exact relationship between the preoperative use of propranolol and the incidence of postoperative JET.

[1]  M. Carmona,et al.  Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery. , 2005, Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.

[2]  T. Spray,et al.  Postoperative junctional ectopic tachycardia in children: incidence, risk factors, and treatment. , 2002, The Annals of thoracic surgery.

[3]  Robert H. Anderson,et al.  Surgical substrates of postoperative junctional ectopic tachycardia in congenital heart defects. , 2002, The Journal of thoracic and cardiovascular surgery.

[4]  A. Garson,et al.  Evolving concepts in the management of congenital junctional ectopic tachycardia. A multicenter study. , 1990, Circulation.

[5]  P. Gillette.  Diagnosis and management of postoperative junctional ectopic tachycardia. , 1989, American Heart Journal.

[6]  S. Yabek,et al.  Electrophysiologic effects of propranolol on sinus node function in children. , 1982, American heart journal.

[7]  J. Copeland,et al.  Plasma propranolol before, during, and after cardiopulmonary bypass , 1981, Clinical pharmacology and therapeutics.

[8]  A. Garson,et al.  Propranolol: the preferred palliation for tetralogy of Fallot. , 1981, The American journal of cardiology.

[9]  A. Wood,et al.  Propranolol Binding in Plasma during Cardiopulmonary Bypass , 1979, Anesthesiology.

[10]  R. Roth,et al.  Role of the Lung in Total Body Clearance of Circulating Drugs , 1979, Clinical pharmacokinetics.

[11]  A. Hohn,et al.  Propranolol palliation of tetralogy of Fallot: experience with long-term drug treatment in pediatric patients. , 1973, Pediatrics.

[12]  G. Cumming,et al.  Hemodynamic effects of propranolol in patients with Fallot's tetralogy. , 1967, American heart journal.

[13]  A. Pellegrini,et al.  [Immediate and late arrhythmia in patients operated on for tetralogy of Fallot]. , 1998, La Pediatria medica e chirurgica : Medical and surgical pediatrics.