Related Experiment Videos
Natural history of isolated atrial flutter in infancy
A Mendelsohn1, M Dick, G A Serwer
1Division of Pediatric Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI 48109-0204.
Insights
Isolated atrial flutter in infancy is rare but has a good prognosis. This condition often self-resolves or responds to transesophageal pacing, suggesting digoxin therapy may be unnecessary.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
Background:
- Isolated atrial flutter in infancy is a rare arrhythmia.
- Its natural history and optimal management require further clarification.
Purpose of the Study:
- To elucidate the natural history of isolated atrial flutter in infants.
- To evaluate the efficacy of different treatment modalities.
Main Methods:
- Retrospective review of nine infants diagnosed with isolated atrial flutter within the first year of life.
- Electrocardiogram and electrogram analysis to identify atrial flutter.
- Assessment of spontaneous conversion, overdrive pacing, and digoxin therapy outcomes.
Main Results:
- Atrial flutter cycle length averaged 151 msec (rate 397 bpm).
- Six patients had co-existing perinatal issues.
- All patients achieved normal sinus rhythm spontaneously (2), with overdrive pacing (4), or digoxin (3).
- Overdrive pacing led to instantaneous conversion; digoxin's role was less clear.
- No recurrence was observed during a mean follow-up of 6.8 years.
Conclusions:
- Isolated atrial flutter in infancy is rare with a favorable prognosis.
- It may be linked to transient perinatal events.
- Spontaneous conversion is common, and transesophageal pacing is effective when needed.
- Long-term digoxin therapy appears unnecessary.
Abstract:
To clarify the natural history of isolated (i.e., without associated congenital cardiac anomalies) atrial flutter in infancy, we reviewed the clinical course in nine patients who were seen with this arrhythmia in the first year of life (range 1 day to 4 months). Atrial flutter was identified by the typical sawtooth pattern in leads II, III, and aVF of the surface electrocardiogram or the pattern of atrial flutter on an atrial electrogram recorded through the esophagus. The mean cycle length of the atrial flutter was 151 msec (atrial rate 397 beats/min). Six of the nine patients had other perinatal problems, such as immune and nonimmune hydrops fetalis (two patients), pneumonia (one patient), anemia (five patients), or low birth weight (one patient). In all patients the rhythm reverted to normal, either spontaneously (two patients), with overdrive pacing (four patients), or after oral digoxin therapy (three patients). No consistent temporal relationship between digoxin administration and conversion was observed; conversion was instantaneous in the four patients who received atrial overdrive pacing. Four patients were discharged receiving digoxin therapy (6 months to 1 year). One patient had supraventricular tachycardia after discharge that was controlled with digoxin. No recurrence of atrial flutter was observed among the nine patients during a mean follow-up of 6.8 years (range 0.2 to 20 years). We conclude that isolated atrial flutter in infancy is rare, has a good prognosis, may be related to transient perinatal events, and often spontaneously converts to normal sinus rhythm; however, when it does not, it will respond to transesophageal pacing. Acute and chronic digoxin therapy is probably unnecessary.