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

^a Division of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Center, MBC J 16, P.O.Box 40047, Jeddah 21499, Saudi Arabia
^b Division of Pediatric Cardiac Intensive Care, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
^c Division of Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia

*Corresponding author. Tel.: +966 2 6677777 5234; fax: +966 2 6639581.

E-mail address: alaabasiouni{at}hotmail.com (A.-B.S. Mahmoud).

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.

Key Words: Tetralogy of Fallot; Junctional ectopic tachycardia; Propranolol