Abstract
BackgroundAtrial tachycardia (AT) is rare in children and can usually be reversed to sinus rhythm with pharmacotherapy and cardioversion. We report a rare case of severe left-sided heart failure due to refractory AT.Case presentationA 12-year-old boy had AT with a heart rate of 180 beats/minute, which was refractory to any medication and defibrillation despite the first attack. Due to rapid cardiorespiratory collapse shortly after arriving at our hospital, central extracorporeal membrane oxygenation (ECMO) with left arterial venting was started immediately. Although AT persisted after that, it stopped on the 3rd day after admission following surgical resection of the left atrial appendage thought to be the source of AT. He was weaned off ECMO on the 7th day and ventilator on the 14th day.ConclusionsThe appropriate timing of central ECMO and surgical ablation were effective in saving this child from a life-threatening situation caused by refractory AT.
Highlights
Atrial tachycardia (AT) is rare in children and can usually be reversed to sinus rhythm with pharmacotherapy and cardioversion
The appropriate timing of central extracorporeal membrane oxygenation (ECMO) and surgical ablation were effective in saving this child from a life-threatening situation caused by refractory AT
The first is the boy had been on central ECMO support for a sudden worsening of hemodynamic and respiratory status due to cardiomyopathy caused by refractory AT despite the first attack, and the second is he underwent surgical resection of left atrial appendage (LAA) to treat AT on ECMO support
Summary
Atrial tachycardia (AT) is one of the rare diseases in pediatric patients [1]. AT attack is treated by antiarrhythmic medication such as adenosine triphosphate (ATP), amiodarone, and β-blocker. Under 150 ml/kg/min of ECMO flow support, we continued to provide amiodarone infusion up to 20 μg/ kg/min and started continuous landiolol infusion up to 10 μg/kg/min His HR was decreased to 140–160 bpm several hours after ECMO induction and was settled down to 100–140 bpm on the 2nd clinical day; his cardiac rhythm was still AT. This child did not have an episode of AT during the ICU stay (Fig. 3) and we could completely discontinue amiodarone and landiolol infusion until the 5th clinical day. His cardiac function was dramatically improved, and we discontinued ECMO support on the 7th clinical day and milrinone on the 20th clinical day.
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