Flutter In Children Research Articles

The diagnostic and therapeutic challenge of atrial flutter in children: a case report

BackgroundPalpitations represent a common cause for consultation in the pediatric Emergency Department (ED). Unlike adults, palpitations in children are less frequently dependent from the heart, recognizing other causes.Case presentationA 11-year-old male came to our pediatric ED for epigastric pain, vomiting and palpitations. During the previous 6 month the patient was affected by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus). Electrocardiogram (ECG) revealed supraventricular tachycardia. Therefore, adenosine was administered unsuccessfully. The administration of adenosine, however, allowed us to make diagnosis of atypical atrial flutter. Multiple attempts at both electrical cardioversion, transesophageal atrial overdrive, and drug monotherapy were unsuccessful in our patient. Consequently, a triple therapy with amiodarone, flecainide, and beta-blocker was gradually designed to control the arrhythmic pattern with the restoration of a left upper atrial rhythm. There was not any evidence of sinus rhythm in the patient clinical history.ConclusionsThe present study underlines the rarity of this type of dysrhythmia in childhood and the difficulties in diagnosis and management, above all in a patient who has never showed sinus rhythm. Raising awareness of all available treatment options is essential for a better management of dysrhythmia in children

Lone Atrial Flutter in Children and Adolescents: Is It Really \u201cLone\u201d?

Atrial flutter (AFL) in children and adolescents beyond the neonatal period in the absence of any underlying myocardial disease (“lone AFL”) is rare and data is limited. Our study aims to present clinical and electrophysiological data of presumed “lone AFL” in pediatric patients and discuss the role of endomyocardial biopsy (EMB) and further follow-up. Since July 2005, eight consecutive patients at a median age of 12.7 (range 10.4–16.7) years presenting with presumed “lone AFL” after negative non-invasive diagnostic work-up had electrophysiological study (EPS) and induction of cavotricuspid isthmus (CTI) conduction block by radiofrequency (RF) current application. In 6/8 patients EMB could be taken. Induction of CTI conduction block was achieved in all patients. Histopathological examination of EMB from the right ventricular septum exhibited myocarditis or cardiomyopathy in 4/6 patients, respectively. During follow-up, 4/8 patients had recurrent arrhythmia (AFL n = 2, wide QRS complex tachycardia n = 1, monomorphic premature ventricular contractions n = 1) after the ablation procedure. 3/4 patients with recurrent arrhythmia had pathological EMB results. The remaining patient with recurrent arrhythmia had a negative EMB but was diagnosed with Brugada syndrome during further follow-up. Taking together results of EMB and further clinical course, only 3/8 patients finally turned out to have true “lone AFL”. Our study demonstrates that true “lone AFL” in children and adolescents is rare. EMB and clinical course revealed an underlying cardiac pathology in the majority of the individuals studied. EMB was very helpful in order to timely establish the diagnosis of myocarditis or cardiomyopathy.

Electrophysiological Characteristics and Outcomes of Radiofrequency Catheter Ablation of Atrial Flutter in Children with or Without Congenital Heart Disease.

There are scarce studies on radiofrequency catheter ablation (RFCA) of atrial flutter (AFL) in the pediatric population. This study therefore aimed to investigate the clinical features and RFCA of AFL in children with or without congenital heart disease. Data from 72 consecutive children (44 males; mean age, 6.1 ± 3.8 [0.9-15.0] years; and mean weight, 23.6 ± 13.9 [8.1-72.0] kg) undergoing RFCA for AFL from 2009 to 2019 were retrospectively reviewed. Thirty-three patients had normal cardiac structure and 39 had congenital heart disease (CHD) of whom 29 had undergone surgical repair and developed AFL at a mean of 3.1 ± 2.5years later. Fifty-nine patients (84%) presented with persistent AFL. Five patients (7%) had cardiac dysfunction with LVEF of 30-48%, which normalized after ablation. Overall, acute success rate of ablation was 99% and recurrence rate was 18% at 0.5-10years of follow-up. No procedure-related complications were identified. All 33 patients with normal cardiac structure had cavotricuspid isthmus (CTI)-dependent AFL. Among patients who had undergone corrective surgery for CHD, 15 (52%) had CTI-dependent AFL, 4 (14%) had surgical incisional scar reentrant AFL and the remaining 10 (34%) had both CTI-dependent and scar reentrant AFL. Success rate (100% vs. 97%, P = 1.0000) and recurrence rate (21% vs. 16%, P = 0.7008) were similar between patients with and without CHD. Overall, sick sinus syndrome (SSS) was found in 42% (30/72) of patients with AFL, with an incidence of 39% (13/33) among patients with normal cardiac structure and 59% (17/29) among those who underwent surgery for congenital defects. Permanent pacemakers (PM) were implanted in 53% (16/30) of patients with SSS after ablation. RFCA therefore appeared efficacious and safe for treatment of pediatric AFL. The mechanisms underlying AFL after corrective surgery for CHD are complex, including CTI-dependent macro-reentrant, scar reentrant, or a combination of both. SSS is not rare among pediatric AFL cases, with approximately half of patients needing PM implantation.

Clinical features and outcomes of radiofrequency catheter ablation of atrial flutter in children

Objective: To explore the clinical features of atrial flutter (AFL) and evaluate the efficacy of radiofrequency catheter ablation (RFCA) for AFL in children. Method: Data were collected and analyzed on 50 consecutive pediatric AFL patients (male 37/female 13) who underwent electrophysiology study and RFCA from February 2009 to November 2016 in a case observational study. The average age was (6.2±3.5) years and body weight was (23.7±13.5) kg. Heart structure was normal in 26 patients. Twenty-four patients had congenital heart disease (CHD) and among them 22 patients underwent repaired surgery before. Patients were followed-up for 1 month to 7 years after RFCA. Clinical features and the outcomes of RFCA in AFL patients were analyzed. Result: The average onset age was (4.2±3.3) years. Of these patients, 84% had persistent AFL and 16% paroxysmal AFL. AFL with sick sinus syndrome (SSS) occurred in 36% patients without statistically significant difference between the groups with and without CHD (38.9%(7/18) vs. 61.1%(11/18), respectively, P=0.239 5); 49 patients underwent RFCA except one case with atrial standstill during the procedure. The total acute success rate was 96%. The follow-up recurrence rate was 8%.No complication of the procedures was observed. The cavotricuspid isthmus-dependent AFL occurred in all patients without CHD. However, in the children with CHD after the repair surgery 10 (45%) cases were with cavotricuspid isthmus-dependent AFL, 4 (8%) with atrial scars-dependent AFL, and 8(16%) with both cavotricuspid isthmus and atrial scars-dependent AFL. Conclusion: RFCA was effective and safe for pediatric AFL. There is no difference on the acute success rate, the follow-up AFL recurrence rate, as well as occurrence of SSS between the groups with and without CHD. AFL patients with CHD included the cavotricuspid isthmus-dependent AFL, atrial scars-dependent AFL or both.

V06 Poster location 006 A case of diaphragmatic flutter in children

V06 Poster location 006 A case of diaphragmatic flutter in children

Clinical analysis of atrial flutter in children

Objective To sum up clinical property and therapeutic experience in the children with atrial flutter.Methods Thirty children with atrial flutter accepted drugs cardioversion therapy firstly.The patients who failed to drugs cardioversion were treated by transesophageal atrial overdrive pacing,synchronized direct current cardioversion or radiofrequency ablation(RFA).Results Of the 30 patients,10 patients gave up treatment.Of 5 patients who suffered from heart failure,3 patients of heart failure were cured.Ten patients recovered to sinus rhythm just by taking medicine.Two cases were treated with transesophageal atrial overdrive pacing and 1 case returned to normal.Synchronized direct current cardioversion were applied in 4 cases,which resulted in 3 cases returning to normal.Three cases received RFA and all responded to therapy.Conclusion Atrial flutter with heart failure in children mostly originate from organic heart disease.Cardioversion rate of drug is high.Transesophageal atrial overdrive pacing and synchronized direct current cardioversion can be used in the treatment of atrial flutter.The experience of RFA in the treatment of atrial flutter in children should be accumulated. Key words: Atrial flutter ; Children ; Treatment ;

New antiarrhythmic drug in pediatric use: sotalol.

Sotalol is a noncardioselective beta-blocking agent with additional class III antiarrhythmic properties (action potential duration prolongation). These combined electrophysiologic effects make it a valuable drug for treating various arrhythmias. Its effectiveness for suppressing supraventricular reentrant tachycardias in children is well documented. Atrial flutter in children can be effectively managed in a high percentage of those treated. Ventricular arrhythmias in children can be adequately controlled by the administration of oral sotalol. Side effects are those typically seen during the course of treatment with a beta-blocker and lead to discontinuation of the drug in 3-6% of children. Proarrhythmia is another concern after sotalol administration. Increased ventricular ectopy, impairment of atrioventricular conduction, and suppression of sinus node activity with exacerbation of bradycardia (especially in children with sinus node dysfunction) may be found in a considerable number of treated patients, usually within a few days of sotalol initiation. Sotalol is an effective antiarrhythmic drug, but its potential side effects warrant inpatient treatment initially and close electrocardiographic monitoring.

Effectiveness of Sotalol for Atrial Flutter in Children After Surgery for Congenital Heart Disease

This study describes the efficacy of oral sotalol in the treatment and prevention of atrial flutter in children after surgery for congenital heart disease. In 11 of 13 children (85%), conversion to sinus rhythm was achieved, and in 8 of 11 within 24 hours.

Atrial Flutter in Children

Atrial Flutter in Children

Atrial Overdrive Pacing for Conversion of Atrial Flutter in Children

Twenty-three successive patients with 27 different episodes of sustained atrial flutter were treated with atrial pacing for conversion of the tachyarrhythmia; 15 patients with 16 episodes of atrial flutter underwent intracardiac right atrial pacing and eight patients with 11 episodes of atrial flutter were treated with transesophageal atrial pacing. Ten of sixteen episodes (63%) and eight of 11 episodes (73%) were successfully converted using intracardiac and transesophageal techniques, respectively. Mean flutter cycle length for all 27 episodes was 219 ms (mean heart rate 274 beats per minute); successful pacing conversion cycle length (n = 15) was 72% of the flutter cycle length. Hemodynamic, electrophysiologic, and roentgenographic data were not predictive of conversion by either technique. Induction of localized atrial fibrillation or failure to meet critical pacing criteria may explain pacing failures. Based on this experience, a trial of transesophageal atrial pacing for acute conversion of any episode of atrial flutter in children prior to direct current cardioversion is recommended.

Auricular tachycardia with auriculoventricular block of 12 years duration in a 16-year-old girl

1. 1. Auricular tachycardia with A-V block and auricular flutter in children have not been reported often and at times they have been hard to differentiate. Evans 8 has presented evidence to suggest that they are essentially the same mechanism. 2. 2. An instance of persistent rapid heart action of thirteen years known duration is reported and is probably best classified as auricular tachycardia with A-V block. For a period of two months the auricular rate apparently changed to 136 and later returned to the original rate. Digitalis enhanced the action of carotid sinus stimulation.