PEDIATRICS Vol. 75 No. 4 April 1985, pp. 725-729
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dunnigan, A.
Right arrow Articles by Benditt, D. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dunnigan, A.
Right arrow Articles by Benditt, D. G.

Atrial Flutter in Infancy: Diagnosis, Clinical Features, and Treatment

Ann Dunnigan MD1, D. Woodrow Benson Jr MD, PhD, FAAP1, and David G. Benditt MD1

1 From the Departments of Pediatrics and Medicine, University of Minnesota Hospitals, Minneapolis

The clinical features and treatment of atrial flutter in eight infants (four male and four female) less than 2 months of age are presented. Atrial flutter was noted during the first week of life in six of the infants and between 6 and 8 weeks of life in the other two infants. Four of the eight infants had associated structural or functional cardiovascular disease, and in three infants a central venous pressure catheter was present in the atrium at the time atrial flutter was diagnosed. Classic flutter waves were apparent on 12-lead ECGs in only two infants. In six infants, flutter waves were not obvious on standard ECGs, but transesophageal electrogram recordings demonstrated the presence of atrial flutter with second degree atrioventricular block. The atrial cycle length during flutter ranged from 135 to 180 ms (mean 149 ms; mean atrial rate 403 beats per minute); there was a 2:1 ventricular response to atrial flutter. Successful termination of atrial flutter was accomplished using three modes of electrical cardioversion in seven of the eight infants: direct curent cardioversion in one, transvenous atrial pacing in one, and transesophageal atrial pacing in five. One asymptomatic infant converted to normal sinus rhythm 24 hours following digoxin administration. One infant had multiple atrial flutter recurrences and required chronic procainamide therapy. In seven of the eight infants, no recurrences have been noted in 6 months to 31/2 years of follow-up. These results demonstrate that atrial flutter may be difficult to diagnose in infants with tachycardia unless transesophageal electrogram recording is utilized for evaluation. In these eight infants, atrial flutter was frequently associated with underlying cardiac disease and/or the presence of central venous pressure catheters in the atrium. Acute treatment with electrical conversion was sufficient in most infants; only one infant required chronic drug therapy to prevent recurrences of atrial flutter.

Key Words: atrial flutter • esophageal catheters • cardioversion

Submitted on March 5, 1984
Accepted on May 7, 1984




This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
K. M. Texter, N. J. Kertesz, R. A. Friedman, and A. L. Fenrich Jr
Atrial Flutter in Infants
J. Am. Coll. Cardiol., September 5, 2006; 48(5): 1040 - 1046.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
M Krapp, T Kohl, J M Simpson, G K Sharland, A Katalinic, and U Gembruch
Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia
Heart, August 1, 2003; 89(8): 913 - 917.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. A. Lisowski, P. M. Verheijen, A. A. Benatar, D. J. G. Soyeur, P. Stoutenbeek, J. I. Brenner, C. S. Kleinman, and E. J. Meijboom
Atrial flutter in the perinatal age group: diagnosis, management and outcome
J. Am. Coll. Cardiol., March 1, 2000; 35(3): 771 - 777.
[Abstract] [Full Text] [PDF]