Multifocal atrial tachycardia in 2 children

Area of Science:

• Pediatric Cardiology
• Cardiac Electrophysiology
• Pediatric Critical Care

Background:

• Multifocal atrial tachycardia (MAT) is an uncommon supraventricular tachycardia, representing less than 1% of cases in pediatric populations.
• Understanding the clinical presentation, treatment strategies, and outcomes of MAT in children is crucial for effective management.

Observation:

• Two pediatric cases of MAT are presented, detailing their distinct clinical courses and interventions.
• The first patient, an infant, experienced respiratory failure and tachycardia, successfully treated with amiodarone, propranolol, and digoxin, eventually converting to sinus rhythm.
• The second patient, a 5-year-old with complex congenital heart disease, developed MAT post-surgery, which resolved rapidly with amiodarone administration.

Findings:

• MAT in children, while rare, can be managed effectively with pharmacologic interventions.
• Amiodarone demonstrated significant efficacy in both cases, rapidly converting MAT to sinus rhythm and resolving associated symptoms.
• Recurrence of MAT in the infant case decreased with age, suggesting a potential link between growth and arrhythmia resolution.

Implications:

• MAT is generally a benign arrhythmia in pediatric patients, especially without severe comorbidities.
• Amiodarone is a recommended first-line pharmacologic agent for managing MAT in children.
• Long-term follow-up is advised for pediatric patients with MAT to monitor for recurrence and ensure sustained sinus rhythm.