Junctional Ectopic Tachycardia
OVERVIEW
- rare
- congenital or post surgery for congenital heart disease
- abnormal automaticity within the His bundle
- high mortality rate (35%)
- autopsy: severe disruption of His-bundles or AV junction
ASSESSMENT
CLINICAL FEATURES
- paediatric patients (birth to 4 weeks)
- antenatal heart failure on U/S
- familial conditions
INVESTIGATIONS
- ECG: junctional tachycardia, rate 160-300, AV dissociation
MANAGEMENT
- unresponsive to DC shock and overdrive pacing
- adenosine infusion can rule out the diagnosis of AV reciprocating tachycardia (tachycardia cycle lengthens but arrhythmia doesn’t terminate)
- treat those with reduced ventricular function or rapid rates
Pharmacological
- amiodarone
- flecanide
- encainide
- propafenone
- anti-failure treatment
Non-pharmacological
- removal of arrhythmogenic area
- surgical His ablation
- pacemaker insertion is controversial
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC