Junctional ectopic tachycardia: Current strategies for diagnosis and management

Abstract

Junctional ectopic tachycardia (JET) is a unique type of supraventricular arrhythmia defined by narrow QRS complex and atrioventricular (AV) dissociation or retrograde atrial conduction in a 1:1 pattern. JET has two forms of presentations: occurring immediately after surgery (post-operative) or a primary idiopathic form presenting in infancy (congenital). Post-operative JET is a potential life threatening tachycardia that mainly occurs after surgical correction of congenital heart defects. In general, it is a self-limiting disorder that usually resolves within one week. However, it can be a potentially serious arrhythmia, associated with hemodynamic compromise and a high morbidity and mortality. Congenital JET occurs in the first six months of life and is usually persistent and sometimes sporadic. Mortality with congenital JET has also been reported to be high. It is thought that both the presentations are due to abnormal automaticity of the AV node or proximal bundle of His. However, the risk factors, etiology and management of these two forms of JET are different. This manuscript reviews the literature on the incidence and risk factors of both forms of JET and current strategies for the diagnosis and management of each form.