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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.

American Heart Journal
|May 1, 1995
PubMed
Summary

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.

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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.

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