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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.

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.

Where does JET originate?

From the AV node or His bundle (abnormal automaticity).

How can we support chronotropy?

Overdrive pacing

What type of onset and offset does JET typically have?

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

What is JET?

A junctional tachyarrhythmia

You’re not sure if it’s sinus or JET. What quick test can help at the bedside?

Atrial ECG - one of the 12-lead EKG (V1) is connected to atrial wires

How does JET affect cardiac output?

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

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

What sedation medication is used to help lower heart rate and reduce sympathetic tone?

Precedex

What will you see in CVP tracing?

Cannon A waves

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.

Why is rewarming dangerous JET?

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

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).

What is AV dissociation?

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