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Atrial flutter in infants

Karen M Texter1, Naomi J Kertesz, Richard A Friedman

  • 1Department of Pediatrics, Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA. kmtexter@texaschildrenshospital.org

Journal of the American College of Cardiology
|September 5, 2006
PubMed

Insights

Infants with atrial flutter (AFL) typically present early in life and often resolve spontaneously or with cardioversion. AFL in infants without other arrhythmias has a low recurrence risk and an excellent prognosis once in sinus rhythm.

Area of Science:

  • Pediatric Cardiology
  • Electrophysiology
  • Neonatal Medicine

Background:

  • Limited large-scale studies exist on the natural history of atrial flutter (AFL) in infants.
  • Previous research on infant AFL has shown variability in treatment approaches and expected outcomes.

Purpose of the Study:

  • To characterize the clinical presentation and outcomes of atrial flutter (AFL) in a large cohort of infants.
  • To evaluate the effectiveness of different treatment modalities for infant AFL.
  • To assess the long-term prognosis for infants diagnosed with AFL.

Main Methods:

  • Retrospective review of medical records for infants under 1 year diagnosed with AFL over 25 years.
  • Exclusion criteria included prior cardiac surgery.
  • Data collected on presentation, clinical findings, interventions, and outcomes.

Main Results:

  • Fifty infants were diagnosed with AFL, with 72% presenting within 48 hours of birth.
  • Congestive heart failure occurred in 10 infants; 26% experienced spontaneous conversion to sinus rhythm.
  • Direct current cardioversion was highly effective (87%) in restoring sinus rhythm, while transesophageal pacing was less effective (32%).

Conclusions:

  • Infant atrial flutter commonly presents within the first two days of life and is not associated with structural heart disease.
  • Direct current cardioversion is the most effective method for achieving sinus rhythm in infants with AFL.
  • Infants with AFL, particularly those without other arrhythmias, have an excellent prognosis and may not require long-term antiarrhythmic therapy after achieving sinus rhythm.
Abstract

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