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Idiopathic atrial flutter in infancy: a review of eight cases
Insights
Digoxin effectively treats atrial flutter in infants without heart issues. For infants with cardiac decompensation, DC countershock is recommended over quinidine.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
Background:
- Atrial flutter is a significant arrhythmia in infants.
- Management strategies for infant atrial flutter without congenital heart disease require clear guidelines.
Purpose of the Study:
- To review institutional experiences in managing atrial flutter in infants under two years old.
- To evaluate the efficacy and safety of different therapeutic approaches, including digoxin and quinidine.
Main Methods:
- Retrospective review of three institutions' management of atrial flutter in infants.
- Analysis of treatment outcomes for infants receiving digoxin versus those requiring DC cardioversion or quinidine.
Main Results:
- Digoxin led to uncomplicated resolution in five neonates with atrial flutter.
- One infant treated with digoxin experienced prolonged paroxysmal supraventricular tachycardia.
- Two older infants required DC cardioversion after quinidine substitution for digoxin therapy.
Conclusions:
- Digoxin remains the preferred initial therapy for non-acutely ill infants with atrial flutter.
- DC countershock is indicated for infants exhibiting signs of cardiac decompensation.
Abstract:
The experience of three institutions in the management of atrial flutter in infants under 2 years of age without associated heart disease is reviewed. Five babies with neonatal onset were treated with digoxin and had uncomplicated resolution of their arrhythmia, although one continued to have episodes of paroxysmal supraventricular tachycardia for six years. Two of the three older infants required DC cardioversion for complications after quinidine was substituted for digoxin therapy. Digoxin continues to be the preferred initial therapy for non-acutely ill patients; those showing signs of cardiac decompensation should be converted with DC countershock.