Ivabradine–Flecainide as Breakthrough Drug Combination for Congenital Junctional Ectopic Tachycardia: A Case Report and Literature Review

Congenital junctional ectopic tachycardia (CJET) is a rare tachyarrhythmia that remains difficult to manage, with suboptimal control in most cases. Here, we report literature research on the use of ivabradine in the treatment of pediatric junctional ectopic tachycardia (JET), both congenital and postoperative, and describe the successful use of ivabradine–flecainide association for CJET therapy resistant to other antiarrhythmic agents. This new drug combination was effective in completely suppressing JET. Ivabradine–flecainide combination may be considered a new therapeutic strategy of CJET with a satisfactory efficacy/tolerability ratio in patients resistant to conventional drug combinations.

Management of post-operative Junctional Ectopic Tachycardia in symptomatic neonates and infants at a tertiary care center in a developing country: Lessons learned!

Purpose: Junctional ectopic tachycardia (JET) is an uncommon form of arrhythmia that occurs after surgical correction of congenital heart defects. Data on neonates and infants are rare. This study highlights the epidemiology, incidence, and management of neonates and infants with JET at a tertiary care center in Lebanon. Methods: We conducted a retrospective chart review between January 1, 2013, and December 31, 2017. All Patients with documented symptomatic junctional ectopic tachycardia on electrocardiogram who required medical treatment post-surgery were included. Results: A total of 9 patients were included. The median age was 18 days, and six were males. Six out of nine (66.67%) were successfully treated with cooling and amiodarone on the initial attempt. The other three cases failed initial treatment with adenosine. However, they were successfully treated with cooling and amiodarone as second-line therapy. All cases of junctional ectopic tachycardia occurred post-surgery at an average of 1.67 ± 1.11 days. Conclusion: Junctional ectopic tachycardia mostly occurs after corrective cardiac surgery and can be successfully treated with cooling and amiodarone. Timely diagnosis significantly affects the outcome.