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How can we support chronotropy?

Overdrive pacing

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baam

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What is AV dissociation?

The atria and ventricles are beating independently—P waves and QRS complexes are no longer linked.

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Why is AV dissociation bad in JET?

Atria to contract against a closed tricuspid valve. Blood to back up into the venous system. Leading to decreased CO.

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What does AV dissociation look like on ECG?

If Atach and 3rd degree linked. P waves are either absent, inverted, or marching through without a consistent PR interval.

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What will you see in CVP tracing?

Cannon A waves

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What is JET?

A junctional tachyarrhythmia

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Why are neonates more at risk?

Small size = more surgical manipulation; immature calcium handling in myocardium (sarcoplasmic reticulum - immature and can't store/release Ca).

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Your patient is post-op Norwood with a Sano shunt. On arrival to the CICU, their core temperature is 34.9°C. To warm or not to warm?

High risk for JET. Plan target temp with team. 35.5-36.0. Rewarm slowely.

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What type of onset and offset does JET typically have?

Gradual — has a “warm-up” and “cooling-down” phase.

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Why is rewarming dangerous JET?

Too fast = ↑ metabolic demand and risk for JET. Always rewarm slowly.

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Name any procedure that increases the risk for JET

Any surgery that involves manipulation near AV node/His bundle. VSD, TOF, AVSD, Truncus, Single Vent palliation

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How does JET affect cardiac output?

Loss of atrial kick + fast HR = ↓ filling time → ↓ stroke volume → ↓ CO

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