Atrial flutter and atrial fibrillation associated with Wolff-Parkinson-White syndrome in childhood

Abstract

Atrial flutter, atrial fibrillation, or both, with the Wolff-Parkinson-White syndrome are reported in four children aged between 6 days and 12 years. The ECGs of all four patients revealed rapid ventricular rates and aberrant intraventricular conduction when atrioventricular (AV) conduction occurred via the accessory connection and slowing of the tachycardia with normalization of the QRS complex when AV conduction occurred via the AV node-His Purkinje system. Three had associated heart disease; one had a chronic congestive cardiomyopathy, one had Ebstein's anomaly of the tricuspid valve, while in the third patient an atrial septal defect was identified. When atrial flutter or fibrillation are combined with accessory AV connections, promotion by digoxin of very fast ventricular rates has been reported in adults but not in infants and older children. In two of our patients, one aged 6 days and one aged 6 months, digoxin may have produced this undesirable effect. Electrophysiologic studies as well as cardiac catheterization may be necessary for complete diagnostic evaluation in such cases. Quinidine should be considered in the management of these patients, and the use of digoxin alone may be contraindicated.