Atrial flutter after insertion of venous catheter in a newborn

Atrial flutter (AFL) is a rare, yet potentially life-threatening tachyarrhythmia of newborns, typically associated with structural heart disease or cardiac surgery. Rarely, AFL might occur as a complication of central venous catheter (CVC) insertion, though data on its incidence and management are limited. Herein, we report the case of a full-term male newborn in therapy with heparin for left iliac thrombosis who developed AFL after a CVC placement. The persistent tachycardia (220 beats per minute) had a narrow QRS and was diagnosed as AFL based on the ECG following adenosine administration; an electrical cardioversion was needed in order to restore the sinus rhythm. Such case highlights the crucial role of real-time tip location techniques in supporting the CVC placement. Indeed, the real-time ultrasound at the bedside might be extremely helpful to promptly assess a CVC mispositioning, allowing for timely and correct management. In conclusion, this case underscores the critical role of real-time ultrasound or intracavitary ECG (IC-ECG) to prevent CVC-related complications and the need for further research into optimizing management strategies for such complications.