[Perinatal Presentation and Complicated Course of a Multifocal Atrial Tachycardia]

Area of Science:

• Pediatric Cardiology
• Neonatal Medicine
• Electrophysiology

Background:

• Supraventricular tachycardia (SVT) is a common neonatal arrhythmia.
• Refractory SVT poses significant management challenges in newborns.
• Early identification and treatment are crucial for favorable outcomes.

Observation:

• A male newborn presented with symptomatic supraventricular tachycardia on day one of life.
• Initial treatments including adenosine and electrical cardioversion were ineffective.
• The tachycardia presented as multifocal atrial tachycardia with episodes of atrial flutter and 2:1 block.

Findings:

• Intravenous esmolol (a beta-receptor blocker) was administered without success.
• Multiple antiarrhythmic medications failed to control recurrent tachycardic episodes.
• High-dose amiodarone (10 mg/kgbw/d) achieved continuous heart rate control and prevented further tachycardic episodes.

Implications:

• This case suggests high-dose amiodarone may be a viable option for refractory neonatal supraventricular tachycardia.
• Effective management of neonatal arrhythmias is essential to prevent adverse cardiovascular events.
• Further research into optimal dosing and long-term safety of amiodarone in neonates is warranted.