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The Secret of Ultra-Rapid Heartbeats: What Are the Real Causes of Conjugated Ectopic Heartbeats?
After heart surgery, some patients may experience a rare heart syndrome called junctional ectopic beats (JET). This is a specific arrhythmia with irregular heartbeats caused primarily by abnormalities in conduction between the atria and ventricles. This article takes an in-depth look at the pathophysiology, diagnosis, treatment, and epidemiology of this syndrome and explores its symptoms in newborns and infants up to six months of age.
Pathophysiology
Electrical activity in a normal heart is initiated by the sinoatrial node (SA node) located in the right atrium, then conducts through the atrioventricular node (AV node), and finally reaches the ventricles. The AV node functions like a gatekeeper, restricting electrical activity from entering the ventricles. This function is particularly important because in certain conditions (such as atrial fibrillation or atrial flutter) the rate of electrical activity in the atria increases and the AV node reduces the electrical shock delivered to the ventricles.
The cause of conjugated ectopic beats is usually an impairment of the normal conductivity between the atria and ventricles, which causes the heart to beat at an abnormally accelerated rate.
In JET patients, a "short circuit" occurs in the heart, which causes electrical signals to skip directly over the AV node, causing the heart to operate at a higher than normal rate. This phenomenon usually occurs within 24 to 48 hours after heart surgery, or even longer.
Diagnosis
The diagnosis of JET mainly relies on a 12-lead electrocardiogram (ECG). This chart typically shows a fast and regular ventricular rate, ranging between 170 and 260 beats per minute. The presence of a narrow QRS waveform on the ECG and the presence of a 1:1 relationship between atrial and ventricular activity supports the diagnosis of JET.
The diagnosis of JET can be confirmed through invasive electrophysiology studies, and once the source of the abnormal electrical activity is identified, treatment becomes more targeted.
Treatment
The main goals of treating JET are to slow the heart rate by correcting acidosis, electrolyte imbalance, lowering body temperature, and using antiarrhythmic drugs. Commonly used drugs include beta-adrenergic receptor antagonists and calcium channel antagonists.
For JET patients who experience poor circulation or compromised cardiac function, cardiac pacing may be required to restore atrium-ventricular coordination.
In some cases, catheter ablation may be a long-term treatment option for patients who develop recurrent JET. This method passes wires into the heart through a small puncture and eliminates the abnormal cells that trigger JET.
Epidemiology
JET occurs more frequently in children, especially after cardiac surgery. Studies have shown that the incidence of JET in children after surgery ranges from 2% to 22%, depending on the type of surgery.
Summary
Conjugated ectopic beats are a complex and challenging condition that requires special attention, especially in patients after cardiac surgery. For this disease, the scientific community still needs further research to clarify its cause and the best treatment. Have you ever thought about how to enable more heart disease patients to receive timely testing and treatment and reduce the impact of JET on their lives?
