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Atrial tachycardia in infants and children: electrocardiographic classification and its significance
1Pediatric Heart Institute, St. Christopher's Hospital for Children, Temple University School of Medicine, Philadelphia, Pennsylvania.
Insights
A new electrocardiographic classification for pediatric atrial tachycardia is proposed. Higher atrial rates (>340/min) predict successful conservative treatment and fewer recurrences in children.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
Background:
- Atrial tachycardia classification and prognostic indicators in children are not well-established.
- Existing electrocardiographic (ECG) criteria may not fully apply to pediatric populations.
Purpose of the Study:
- To establish an electrocardiographic classification for pediatric atrial tachycardia.
- To determine the prognostic significance of atrial rate and P-wave axis in children with atrial tachycardia.
Main Methods:
- Retrospective review of clinical histories and 12-lead ECGs from 21 children with atrial tachycardia.
- Classification of tachycardia based on atrial rate (<340/min vs. >340/min).
- Analysis of P-wave axis and treatment response.
Main Results:
- Children with atrial tachycardia rate >340/min showed consistent response to conservative treatment (digoxin/cardioversion) without recurrence (p < 0.05 and p > 0.025).
- Only one child with atrial rate <340/min responded to conservative therapy.
- P-wave axis did not correlate with prognosis.
- Higher atrial rates were observed in infants compared to older children.
Conclusions:
- An electrocardiographic classification based on atrial rate is clinically useful for managing pediatric atrial tachycardia.
- Higher atrial rates (>340/min) are associated with a favorable treatment response and lower recurrence rates in children.
- Age-related differences in atrial rate may exist in pediatric atrial tachycardia.
Abstract:
An electrocardiographic classification of atrial tachycardia and its significance in children has not been reported. We reviewed the clinical histories and 12-lead surface electro-cardiograms (ECG) of 21 children with atrial tachycardia. Atrial rate and P-wave axis were determined for each patient. Some patients had features of typical atrial flutter (AF). Tachycardia was classified by atrial rate < 340/min or atrial rate > 340/min. Children with atrial tachycardia rate > 340/min consistently responded to conservative treatment (digoxin and/or cardioversion) without recurrences (p < 0.05 and p > 0.025); whereas in children with atrial rate < 340/min, only one case responded to conservative therapy. P-wave axis had no prognostic significance for either group. Additionally, high atrial rate (> 340/min) during tachycardia was noted in early infancy, compared to older children and adults, and probably represents the function of age. Classification of atrial tachycardia by rate is clinically useful for planning therapy and predicting response in children.