Question

A 2-year-old boy is brought to the intensive care unit after the intracardiac repair for Tetralogy of Fallot.
How will you manage junctional tachycardia in this context?

Hint:

Junctional tachycardia requires prompt recognition and management to prevent hemodynamic instability in post-operative pediatric patients.

Answer 1

Step 1: Understanding Junctional Tachycardia:
Junctional tachycardia is a type of arrhythmia that originates from the atrioventricular junction. It is characterized by a rapid heart rate, often above 100 beats per minute. In a post-operative patient, this condition could be triggered by the surgical procedure, hypoxia, electrolyte imbalances, or as a side effect of medications.
Step 2: Management of Junctional Tachycardia:
1. Stabilization: Ensure adequate oxygenation and ventilation, as hypoxia may worsen the arrhythmia.
2. Electrolyte Correction: Correct any electrolyte imbalances, particularly hypokalemia and hypomagnesemia, which can contribute to arrhythmias.
3. Vagal Maneuvers: Non-invasive techniques such as vagal maneuvers (e.g., ice to the face or carotid massage) may be attempted in some cases.
4. Pharmacologic Treatment: Adenosine is the first-line treatment for acute management of junctional tachycardia.
5. Antiarrhythmic Agents: If adenosine is not effective, other antiarrhythmic agents like amiodarone or procainamide may be used.
6. Electrocardioversion: In cases of severe or refractory tachycardia, synchronized cardioversion may be required.