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Atrial flutter in infancy: diagnosis, clinical features, and treatment
Insights
Diagnosing atrial flutter in infants is challenging, often requiring transesophageal electrograms. However, treatments like electrical cardioversion and pacing are effective in terminating this condition.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Neonatal Medicine
Background:
- Atrial flutter is a rare but serious cardiac arrhythmia in infants.
- Early diagnosis and treatment are crucial for favorable outcomes.
Purpose of the Study:
- To describe the clinical features, diagnosis, and treatment of atrial flutter in infants.
- To evaluate the effectiveness of different cardioversion methods.
Main Methods:
- Retrospective review of eight infants diagnosed with atrial flutter.
- Analysis of electrocardiograms (ECGs) and transesophageal electrograms.
- Assessment of treatment outcomes including cardioversion and long-term follow-up.
Main Results:
- Atrial flutter was diagnosed within the first 8 weeks of life in all infants.
- Classic flutter waves were only seen on 12-lead ECGs in two infants; transesophageal electrograms were key for diagnosis.
- Electrical cardioversion (DC, transvenous, or transesophageal pacing) successfully terminated atrial flutter in seven of eight infants.
- One infant converted with digoxin, and another required chronic procainamide for recurrent flutter.
Conclusions:
- Atrial flutter in infants can be difficult to diagnose using standard ECGs.
- Transesophageal electrogram recordings are essential for accurate diagnosis.
- Electrical cardioversion and pacing are effective treatments for infant atrial flutter.
Abstract:
The clinical features and treatment of atrial flutter in eight infants (four male and four female) less than 2 months of age are presented. Atrial flutter was noted during the first week of life in six of the infants and between 6 and 8 weeks of life in the other two infants. Four of the eight infants had associated structural or functional cardiovascular disease, and in three infants a central venous pressure catheter was present in the atrium at the time atrial flutter was diagnosed. Classic flutter waves were apparent on 12-lead ECGs in only two infants. In six infants, flutter waves were not obvious on standard ECGs, but transesophageal electrogram recordings demonstrated the presence of atrial flutter with second degree atrioventricular block. The atrial cycle length during flutter ranged from 135 to 180 ms (mean 149 ms; mean atrial rate 403 beats per minute); there was a 2:1 ventricular response to atrial flutter. Successful termination of atrial flutter was accomplished using three modes of electrical cardioversion in seven of the eight infants: direct current cardioversion in one, transvenous atrial pacing in one, and transesophageal atrial pacing in five. One asymptomatic infant converted to normal sinus rhythm 24 hours following digoxin administration. One infant had multiple atrial flutter recurrences and required chronic procainamide therapy. In seven of the eight infants, no recurrences have been noted in 6 months to 3 1/2 years of follow-up. These results demonstrate that atrial flutter may be difficult to diagnose in infants with tachycardia unless transesophageal electrogram recording is utilized for evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)