Atrial Flutter-Unique Arrhythmia in Neonatal Population, Presentation of 3 Cases

Kędziora P, Stasiak A.Adv Neonatal Care. 2020 May 1. doi: 10.1097/ANC.0000000000000737. Online ahead of print.PMID: 32366806



Background: Atrial flutter (AFL) is an uncommon arrhythmia in the pediatric population. It is defined as fast ordered atrial depolarization (about 250-500 beats/min). It occurs mainly in children with congenital heart defects; however, it may also manifest in fetuses and infants with an anatomically healthy heart. In neonates, AFL is most often revealed within the first 2 days after birth.

Clinical findings: In this case report, we present 3 neonates without complex congenital heart defects with AFL, along with the description of the course, diagnostic and therapeutic processes depending on the clinical condition of a child, and response to treatment.

Primary diagnosis: Symptoms in this group of patients are nonspecific, that is, tachypnea, unwillingness to eat, and fatigue while feeding. The diagnostic process included thorough electro- and echocardiographic assessments. Each child was treated individually due to a different cause of arrhythmia and comorbidities.

Interventions: Invasive (electrical cardioversion) and pharmacological methods were used in treatment to achieve conversion to sinus rhythm.

Outcomes: One patient required electrical cardioversion, one was treated with amiodarone and digoxin, and one infant received amiodarone. All children achieved conversion to sinus rhythm.

Practice recommendations: During the follow-up, each child maintained sinus rhythm, which shows that in the neonatal group, it is a unique, but well-controlled, arrhythmia once conversion to sinus rhythm is achieved.