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Elevated impedance during cardioversion in neonates with atrial flutter.

Scott R Ceresnak1, Thomas J Starc, Allan J Hordof

  • 1The Children's Hospital of New York-Morgan Stanley Children's Hospital-Columbia, New York, NY 10032, USA. ceresnak@yahoo.com

Pediatric Cardiology
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Summary
This summary is machine-generated.

Direct-current cardioversion for neonatal atrial flutter requires higher energy due to elevated impedance. Successful cardioversion was achieved with low current, suggesting specific energy needs for this patient population.

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Area of Science:

  • Neonatal cardiology
  • Pediatric electrophysiology
  • Critical care medicine

Background:

  • Direct-current cardioversion is a standard treatment for neonatal atrial flutter.
  • Pediatric studies suggest low energy (0.25-0.5 J/kg) is effective with biphasic devices.
  • Neonatal impedance during cardioversion is not well-characterized.

Purpose of the Study:

  • To investigate the electrical impedance and energy requirements for direct-current cardioversion in neonates with atrial flutter.
  • To determine if higher energy levels than typically used in children are necessary for successful cardioversion in this population.

Main Methods:

  • Retrospective chart review of neonates undergoing cardioversion for atrial flutter (2005-2008).
  • Inclusion criteria: neonates with atrial flutter requiring cardioversion and available ECG strips.
  • Analysis of electrical impedance and energy delivered for successful cardioversion.

Main Results:

  • Six neonates met the inclusion criteria; median age 2.6 hours, mean weight 3.22 kg.
  • Mean electrical impedance during successful cardioversion was elevated at 234 ± 136 Ω.
  • Mean delivered energy for successful cardioversion was 0.9 ± 0.3 J/kg with a consistent 1 A current.

Conclusions:

  • Neonates with atrial flutter exhibit elevated electrical impedance during direct-current cardioversion.
  • Successful cardioversion was achieved with a mean energy of 0.9 J/kg, indicating higher requirements than in older children.
  • Low current was sufficient, but further research is needed to optimize cardioversion strategies in neonates.