Related Experiment Videos
Chaotic atrial rhythm in children
H Dodo1, R M Gow, R M Hamilton
1Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Chaotic atrial rhythm (CAR) in children is challenging to treat, often requiring multiple antiarrhythmic drugs like amiodarone and propafenone. While some cases resolve over time, CAR remains difficult to control in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
Background:
- Chaotic atrial rhythm (CAR) is typically seen in adults with chronic obstructive lung disease.
- CAR in neonates and infants is rare, presenting unique clinical challenges.
Purpose of the Study:
- To describe the clinical manifestations of CAR in a pediatric cohort.
- To evaluate the efficacy of antiarrhythmic therapies, including propafenone and amiodarone, in managing pediatric CAR.
- To assess the long-term outcomes and resolution rates of CAR in children.
Main Methods:
- Retrospective case series of nine pediatric patients diagnosed with CAR.
- Analysis of clinical presentation, cardiac abnormalities, and treatment regimens.
- Evaluation of drug efficacy, including intravenous and oral antiarrhythmic agents.
- Assessment of short-term and long-term patient outcomes.
Main Results:
- Six of nine patients were neonates (< 2 weeks old) presenting with tachycardia or congestive heart failure.
- Eight patients had underlying cardiac abnormalities.
- Intravenous therapy was ineffective for rhythm conversion.
- A combination of amiodarone and propafenone, with other agents, showed the most success in rate control.
- Seven patients were discharged with varying degrees of CAR control; two neonates with hypertrophic cardiomyopathy died.
- CAR resolved in five patients during long-term follow-up, persisting in two.
Conclusions:
- Pediatric CAR is a severe condition, often associated with cardiac abnormalities and difficult to manage.
- Amiodarone and propafenone are key agents in managing pediatric CAR, though complete control is challenging.
- While CAR is difficult to treat, spontaneous resolution may occur over time.
Abstract:
Chaotic atrial rhythm (CAR) usually occurs as a sequela of chronic obstructive lung disease in adults. We report the clinical manifestations and response to therapy in nine children with CAR treated predominantly with propafenone or amiodarone. Age at presentation ranged from 1 day to 30 months; six patients were < or = 2 weeks old. Six patients had tachycardia, and three had congestive heart failure. The atrial rate was 200 to 500 (mean 369 +/- 71) beats/min and the ventricular rate 150 to 300 (mean 251 +/- 37) beats/min. Eight patients had cardiac abnormalities. Intravenous drug therapy was not successful in converting CAR to sinus rhythm in any patient. A mean of four (range three to five) drugs was used in each patient; amiodarone and propafenone, alone or in combination, proved most successful. Seven patients were discharged from the hospital: full control was achieved in three (digoxin and amiodarone in two and digoxin, amiodarone, and procainamide in one), good control in three (digoxin, amiodarone, and propafenone in two and digoxin and propafenone in one), and ventricular rate control in one (digoxin, amiodarone, and propafenone). Two neonates with hypertrophic cardiomyopathy died. Long-term follow-up showed that CAR had resolved in five patients but persisted in two. We conclude that CAR remains difficult to control despite the use of newer antiarrhythmic agents but may resolve during long-term follow-up.