Atrial flutter in fetuses and early childhood: a report of eight cases

Atrial flutter is an uncommon arrhythmia in children. The presenting features and treatment responses of two fetuses and six children with atrial flutter were presented. Two patients were diagnosed prenatally at 31 and 35 weeks' gestation. One patient was successfully controlled in utero by maternal administration of digoxin and the other by direct current cardioversion after delivery. Two fetuses and 2 of 6 children had normal cardiac structure by echocardiogram. Three patients had right atrial enlargement due to atrial primun septal defect, secundum atrial septal defect with primary pulmonary hypertension, and endomyocardial fibrosis. One patient developed atrial flutter with sinus node dysfunction after surgical correction of total anomalous pulmonary venous connection. Four cases presented as atrial flutter with regular atrioventricular conduction (2:1 or 3:1 conduction) while the remainder presented with irregular atrioventricular conduction. Heart failure was presented in two patients and improved after the arrhythmias were controlled. Successful termination of atrial flutter was accomplished by using DC cardioversion in 4 patients and one patient converted to normal sinus rhythm following combination of digoxin and amiodarone administration. Digoxin was administered for one year as the prophylactic medication in six patients. None had recurrence of atrial flutter during the follow-up period of one to four years. Two patients required chronic digoxin and amiodarone therapy. We concluded that atrial flutter in fetuses and early childhood carries a good prognosis. Acute treatment with direct current cardioversion is sufficient in most patients, combination of digoxin and amiodarone may be an alternative therapy to convert atrial flutter.