Atrial Flutter in the Neonate: A Case Study

Cardiac Arrhythmias Requiring Electric Countershock during the Neonatal Period-A Systematic Review

BACKGROUND

In neonates, cardiac arrhythmias are rare. Electric countershock therapy is an effective alternative to drug therapy for neonatal arrhythmias. There are no randomized controlled studies investigating electric countershock therapy in neonates.

OBJECTIVE

To identify all studies and publications describing electric countershock therapy (including defibrillation, cardioversion, and pacing) in newborn infants within 28 days after birth, and to provide a comprehensive review of this treatment modality and associated outcomes.

METHODS

For this systematic review we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). All articles reporting electric countershock therapy in newborn infants within 28 days after birth were included.

RESULTS

In terms of figures, 113 neonates who received electric countershock due to arrhythmias were reported. Atrial flutter (76.1%) was the most common arrhythmia, followed by supraventricular tachycardia (13.3%). Others were ventricular tachycardia (9.7%) and torsade de pointes (0.9%). The main type of electric countershock therapy was synchronized cardioversion (79.6%). Transesophageal pacing was used in twenty neonates (17.7%), and defibrillation was used in five neonates (4.4%).

CONCLUSION

Electric countershock therapy is an effective treatment option in the neonatal period. In atrial flutter especially, excellent outcomes are reported with direct synchronized electric cardioversion.

Atrial Flutter-Unique Arrhythmia in Neonatal Population, Presentation of 3 Cases

BACKGROUND

Atrial flutter (AFL) is an uncommon arrhythmia in the pediatric population. It is defined as fast ordered atrial depolarization (about 250-500 beats/min). It occurs mainly in children with congenital heart defects; however, it may also manifest in fetuses and infants with an anatomically healthy heart. In neonates, AFL is most often revealed within the first 2 days after birth.

CLINICAL FINDINGS

In this case report, we present 3 neonates without complex congenital heart defects with AFL, along with the description of the course, diagnostic and therapeutic processes depending on the clinical condition of a child, and response to treatment.

PRIMARY DIAGNOSIS

Symptoms in this group of patients are nonspecific, that is, tachypnea, unwillingness to eat, and fatigue while feeding. The diagnostic process included thorough electro- and echocardiographic assessments. Each child was treated individually due to a different cause of arrhythmia and comorbidities.

INTERVENTIONS

Invasive (electrical cardioversion) and pharmacological methods were used in treatment to achieve conversion to sinus rhythm.

OUTCOMES

One patient required electrical cardioversion, one was treated with amiodarone and digoxin, and one infant received amiodarone. All children achieved conversion to sinus rhythm.

PRACTICE RECOMMENDATIONS

During the follow-up, each child maintained sinus rhythm, which shows that in the neonatal group, it is a unique, but well-controlled, arrhythmia once conversion to sinus rhythm is achieved.