[Supraventricular tachycardia in infants]. / Les troubles du rythme supraventriculaires chez le nourrisson et l'enfant. À propos de six cas.

Supraventricular tachycardia in infants are variable. We try to summarize clinical, electrical and treatment particularities of supraventricular arrhythmia in infants. The majority of infants with supraventricular arrhythmia have a good clinical outcome and an excellent prognosis and may not require chronic antiarrhythmic therapy if they had precocious treatment.

Perinatal isolated atrial flutter associated with maternal cocaine and opiate use in a late preterm infant.

Atrial flutter is a serious form of neonatal tachyarrhythmia. Maternal drug use of cocaine and/or opiate is associated with central and autonomic nervous signs in fetuses and newborn infants. The fetal cardiovascular effects of cocaine and opiate exposure are not well characterized. We present the case of isolated atrial flutter in a late preterm infant who has been perinatally exposed to cocaine and opiate.

Neonatal intractable atrial flutter successfully treated with intravenous flecainide.

We present a neonatal case with intractable atrial flutter that did not respond to digitalization and electrical cardioversion. Intravenous flecainide administration completely resolved the atrial flutter. Proarrhythmic effects were not induced by flecainide administration. Although the efficacy of flecainide for atrial flutter during the infantile or childhood period is low, intravenous flecainide is worth consideration as a treatment for atrial flutter, even in intractable cases as described here, during the neonatal period.

Voltage and activation mapping: how the recording technique affects the outcome of catheter ablation procedures in patients with congenital heart disease.

BACKGROUND: Endocardial mapping is mandatory before radiofrequency catheter ablation (RFCA). Mapping can be performed with either unipolar or bipolar recordings. Impact of the recording technique used was studied in patients with and without structural heart disease using the 3D electroanatomic CARTO mapping system. METHODS AND RESULTS: Patients (n=44; 16 males; age 43+/-16 years) referred for RFCA of atrial flutter (AFL, n=18), focal atrial tachycardia (FAT, n=4), AV nodal reentrant tachycardia (AVNRT, n=5), or scar-related atrial reentrant tachycardia (IART, n=17) were studied. Voltage and activation maps were constructed. Unipolar and bipolar voltage distribution in the different groups was studied to establish a cutoff voltage value to facilitate delineation of scar tissue. Electrograms were recorded during tachycardia (FAT: n=246, cycle length [CL]=449+/-35 ms; AVNRT: n=182, CL=359+/-47 ms; AFL: n=1164, CL=255+/-56 ms; IART: n=2431, CL=280+/-74 ms). Unipolar voltages were greater than bipolar voltages (P<0.001). Unipolar voltages < or =1.0 mV were equally distributed in both AFL and IART patients. Bipolar voltages < or =0.1 mV were only found in patients with IART, and subsequently 0.1 mV was used as the cutoff value to delineate scar tissue. No unipolar cutoff value could be established. Timing of unipolar and bipolar local activation was correlated in all patient groups. CONCLUSIONS: The recording technique used has considerable impact on reconstruction of reentrant pathways and on the outcome of RFCA. In general, unipolar and bipolar recordings provide complementary information; however, only bipolar recordings allow voltage-based scar tissue delineation in patients with congenital heart disease.

[A case of congenital atrial flutter associated with atrial septal defect].

We report the case of a 8-month-old boy with atrial septal defect associated with congenital atrial flutter. He was operated on for ASD successfully. Atrial flutter in infants has been reported to be uncommon and to have a poor prognosis when associated with underlying cardiac disease. Therefore, early surgical intervention may improve the prognosis.

Successful treatment of congenital atrial flutter with antitachycardia pacing.

Congential atrial flutter is a condition that rarely requires chronic pharmacological therapy. An unusual case of congenital atrial flutter is described which was resistant to medical therapy, yet responded well to antitachycardia pacing. While most experience with antitachycardia pacing in pediatrics has been with the postoperative congenital heart patient, patients such as the one described with unscarred atria may prove to be the most suitable pediatric candidates for this pacing modality.

Flutter atrial no recém-nascido: relato de três casos / Atrial flutter in the newborn: report of 3 cases

O trabalho relata três casos de flutter atrial congênito: as três crianças eram do sexo masculino, duas brancas e uma amarela, e o diagnóstico do flutter atrial congênito do tipo I realizado nos primeiros dias de vida por apresentarem sinais de insuficiência cardíaca e/ou freqüência cardíaca elevada. A terapêutica anti-arrítmica adotada consistiu na associaçäo de digoxina e quinidina, tendo sido necessária cardioversäo elétrica em un dos casos. Ressalta-se a raridade da arritmia e a necessidade do diagnóstico precoce, assim como da abordagem terapêutica adequada para obtençäo de bons resultados

Transplacental passage of digoxin in the case of nonimmune hydrops fetalis.

Successful treatment of intrauterine fetal tachyarrhythmia was reported in several cases recently. It was also pointed out that placental transfer of digoxin is unsatisfactory under certain conditions. However, it has not been clearly shown in which cases fetal digoxin level does not reach the maternal level. We present a case of nonimmune hydrops fetalis due to congenital atrial flutter in which digoxin concentration in the sera of the mother and the neonate showed significant dissociation, and discuss perinatological matters about the digoxin treatment and the factor that obstructs the transplacental passage of digoxin. Conclusively, we recommend that maternal digoxin concentration should be raised to near toxic level if the resolution of fetal and placental hydrops is not attained in the initial digoxin loading.

Fetal atrial flutter and X-linked dominant vitamin D-resistant rickets.

A pregnancy, complicated by hypophosphatemic familial rickets (vitamin D-resistant rickets) of a female fetus, associated with atrial flutter and congestive heart failure is presented. Upon review of the literature, only 22 cases of fetal atrial flutter have been reported. The association between hypophosphatemic familial rickets and atrial flutter has not yet been described.

Fetal cardiac arrhythmia: antepartum diagnosis of a case of congenital atrial flutter.

A case of antepartum atrial tachyarrhythmia was detected in the 36th week of pregnancy. Cardiotocograph recordings done twice daily enabled close surveillance of the fetal condition after oxytoxin challenge testing had failed to show evidence of hypoxia. After a diagnosis of fetal cardiac arrhythmia had been made, elective caesarean section in the 40th week of pregnancy resulted in delivery of an infant in atrial flutter and cardiac failure. Both these problems were soon resolved by cardioversion and subsequent treatment with digoxin. Cardiac catheterisation showed no underlying cardiac abnormality. Increasing use of antenatal cardiotocography may show that intrauterine tachyarrhythmias are more common than had generally been believed.

Idiopathic atrial flutter in infancy: a review of eight cases.

The experience of three institutions in the management of atrial flutter in infants under 2 years of age without associated heart disease is reviewed. Five babies with neonatal onset were treated with digoxin and had uncomplicated resolution of their arrhythmia, although one continued to have episodes of paroxysmal supraventricular tachycardia for six years. Two of the three older infants required DC cardioversion for complications after quinidine was substituted for digoxin therapy. Digoxin continues to be the preferred initial therapy for non-acutely ill patients; those showing signs of cardiac decompensation should be converted with DC countershock.

Cardiac malformations presenting as congenital atrial flutter.

A case of congenital atrial flutter with tetralogy of Fallot is presented. Fetal tachycardia was detected three weeks prior to birth and digitalization converted the arrhythmia to a normal sinus rhythm at two days of age. The seven previously reported cases of congenital atrial flutter associated with congenitally malformed hearts are reviewed.

Congenital atrial flutter.

Two cases of congenital atrial flutter, one of which was documented electrocardiographically before birth, are reported. In both patients sinus rhythm was restored with digoxin treatment; in one patient the transition was preceded by various arrhythmias. No cardiac malformation was found in either case, and no materal disease occurred during pregnancy. Both mothers had received medication during pregnancy, but its role as a causative factor is questionable.