Clinical manifestations of childhood chaotic atrial tachycardia

Abstract

Objective To study the clinical characteristics of children with chaotic atrial tachycardia (CAT), and to improve its clinical diagnosis and treatment. Methods Clinical data, follow-up, treatment and prognosis concerning 33 patients with CAT from Sep.2001 to Oct.2013 in Beijing Children's Hospital were analyzed. Results The 33 patients included 23 boys and 10 girls with ages ranging from 3 days to 13 months, 5 months on the average.CAT was conformed by electrocardiogram in all patients: multifocal atrial tachycardia defined by 3 distinct P'-waveforms, irregular P'R, RR and P'-P' intervals, and isoelectric baseline between P'-waves.Combined with symptoms of atrial flutter, atrial fibrillation, atrial premature beats, atrial tachycardia, and interior conduction, differences were detected by 24-hour holter electrocardiography.Echocardiographic features indicated mild heart enlargement in 19 cases, medium enlargement in 4 cases, severe enlargement in 3 cases, atrial septal defect in 5 cases, ventricular septal defect in 3 cases, atrial septal defect coupled with patent ductus arteriosus in 1 case, congenital total anomalous pulmonary venous connection in 1 case, and patent foramen ovale closure in 12 cases.Twenty-three patients had heart failure.Digoxine, amiodarone and Betaloc were administered to the patients for maintaining their heart functions.No antiarrhythmic drug therapy was used in 2 patients.Twenty-six of the patients (78.8%) had normal electrocardiographic sinus rhythm within 3 to 18 months after their discharge from hospital.Three of the patients (9.1%) still had CAT symptoms in their eletroccardiogram, but their heart rates were kept under control during the 12-month follow-up clinical visits.Of 26 children with cardiac enlargement, echocardiograms in 21 cases (80.8%) returned to normal within 1-3 months after their electrocardiograms returned to normal, and for the other 5 cases (19.2%), the recovery took 6-12 months.One patient died and 3 patients did not participate in the follow-up visits. Conclusions CAT is often found in newborns and infants.Its diagnosis relies on electrocardiography and 24-hour holter electrocardiography.Treatment with Digoxine, and/or β-receptor block, and amiodarone according to with the heart functions of patients can restore sinus rhythm, and achieve good prognostic results. Key words: Chaotic atrial tachycardia; Diagnosis; Treatment; Child