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PEDIATRICS Vol. 100 No. 2 August 1997, p. e11
Copyright ©1997 by the American Academy of Pediatrics

ELECTRONIC ARTICLE:
Atrial Flutter: An Uncommon Pediatric Manifestation of Hyperthyroidism

Received Oct 31, 1996; accepted Feb 18, 1997.

William A. Suarez, George F. Van Hare, and Isaiah D. Wexler

Divisions of Cardiology and Endocrinology Department of Pediatrics Case Western Reserve University School of Medicine Cleveland, OH 44106

James E. Arnold

Division of Pediatric Otolaryngology Department of Otolaryngology-Head and Neck Surgery Case Western Reserve University School of Medicine Cleveland, OH 44106

Objective.  Atrial flutter is an uncommon arrhythmia in the pediatric population except for the immediate newborn period or following atrial repair of congenital heart disease. In children the diagnosis of atrial flutter may be difficult, attributable to rapid atrioventricular conduction and superimposition of flutter waves on QRS and T waves. Atrial flutter secondary to hyperthyroidism has been rarely reported in older adults, but there are no reports of children presenting with atrial flutter as the initial manifestation of hyperthyroidism.

Case Report.  We report an interesting case of hyperthyroidism in a 3-year-old presenting with congestive heart failure and atrial flutter with 1:1 atrioventricular conduction. The responses to adenosine administration and to cardioversion were unusual and ultimately helpful in suggesting the diagnosis of hyperthyroidism.

Conclusion.  When atrial flutter is encountered in a pediatric patient in whom there is 1:1 atrioventricular conduction, a lack of a response to adenosine, and persistent sinus tachycardia after cardioversion, the clinician should be alert to the possibility of thyrotoxicosis.

Key words: atrial flutter, hyperthyroidism, pediatric, adenosine.