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A genetic contribution to risk for postoperative junctional ectopic tachycardia in children undergoing surgery for congenital heart disease.

ABSTRACT: Junctional ectopic tachycardia (JET) is a common arrhythmia complicating pediatric cardiac surgery, with many identifiable clinical risk factors but no genetic risk factors to date.To test the hypothesis that the angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism associates with postoperative JET.DNA samples were collected from children undergoing the Norwood procedure; arterial switch operation; and repairs of Tetralogy of Fallot, balanced atrioventricular septal defect, and ventricular septal defect at a single center. The incidence of postoperative JET was associated with previously identified clinical risk factors and ACE I/D genotype.Of the 174 children who underwent the above-mentioned surgeries, 21% developed JET. Postoperative JET developed in 31% of children with the D/D genotype but only in 16% of those with the I/I genotype or the I/D genotype (P = .02). Clinical predictors of JET were selected a priori and included age, inotrope score, cardiopulmonary bypass time, and cross-clamp time. Multivariable logistic regression identified a significant correlation between the D/D genotype and postoperative JET independent of these predictors (odds ratio = 2.4; 95% confidence interval, 1.04-5.34; P = .04). A gene-dose effect was apparent in the homogeneous subset of subjects with atrioventricular septal defect (58% JET in D/D subjects, 12% JET in I/D subjects, and 0% JET in I/I subjects; P <.01).The common ACE deletion polymorphism is associated with a greater than 2-fold increase in the odds of developing JET in children undergoing surgical repair of atrioventricular septal defect, Tetralogy of Fallot, ventricular septal defect or the Norwood and arterial switch procedures. These findings may support the potential role of the renin-angiotensin-aldosterone system in the etiology of JET.

SUBMITTER: Borgman KY

PROVIDER: S-EPMC3215859 | biostudies-other | 2011 Dec

REPOSITORIES: biostudies-other

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A genetic contribution to risk for postoperative junctional ectopic tachycardia in children undergoing surgery for congenital heart disease.

Borgman Kristie Y KY Smith Andrew H AH Owen Jill P JP Fish Frank A FA Kannankeril Prince J PJ

Heart rhythm 20110706 12

<h4>Background</h4>Junctional ectopic tachycardia (JET) is a common arrhythmia complicating pediatric cardiac surgery, with many identifiable clinical risk factors but no genetic risk factors to date.<h4>Objective</h4>To test the hypothesis that the angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism associates with postoperative JET.<h4>Methods</h4>DNA samples were collected from children undergoing the Norwood procedure; arterial switch operation; and repairs of Tetralogy o ...[more]

PMID: 21740877

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Project description:AimWe explored the association between preoperative anthropometry and biochemistry, and postoperative outcomes in infants with CHD after cardiac surgery, as infants with congenital heart disease (CHD) often have feeding difficulties and malnutrition.MethodologyThis was a retrospective review of infants (≤ 1-year-old) who underwent congenital heart surgery. Preoperative anthropometryin terms of preoperative weight-for-age z-score (WAZ), length-for-age z-score (LAZ), as well as preoperative serum albumin and hemoglobin concentrations, were evaluated against 6-month mortality, and morbidity outcomes including postoperative complications, vasoactive inotrope score, duration of mechanical ventilation, length of stay in the pediatric intensive care unit and in hospital, using the logistic regression or median regression models accounting for infant-level clustering.ResultsOne hundred and ninety-nine operations were performed in 167 infants. Mean gestational age at birth was 38.0 (SD 2.2) weeks (range 26 to 41 weeks). Thirty (18.0%) infants were born preterm (<37 weeks). The commonest acyanotic and cyanotic lesions were ventricular septal defect (26.3%, 44/167), and tetralogy of Fallot (13.8%, 23/167), respectively. Mean age at cardiac surgery was 94 (SD 95) days. Feeding difficulties, including increased work of breathing during feeding, diaphoresis, choking or coughing during feeding, and inability to complete feeds, was present in 54.3% (108/199) of infants prior to surgery, of which 21.6% (43/199) required tube feeding. The mean preoperative WAZ was-1.31 (SD 1.79). Logistic regression models showed that low preoperative WAZ was associated with increased risk of postoperative complications (odds ratio 1.82; p = 0.02), and 6-month mortality (odds ratio 2.38; p = 0.008) following CHD surgery. There was no meaningful association between the other preoperative variables and other outcomes.ConclusionMore than 50% of infants with CHD undergoing cardiac surgery within the first year of life have feeding difficulties, of which 22% require to be tube-fed. Low preoperative WAZ is associated with increased postoperative complications and 6-month mortality.

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A genetic contribution to risk for postoperative junctional ectopic tachycardia in children undergoing surgery for congenital heart disease.

Publications

A genetic contribution to risk for postoperative junctional ectopic tachycardia in children undergoing surgery for congenital heart disease.

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