Evaluation and Management of Recurrent Atrial Flutter in Neonates

Background: Fetal tachyarrhythmias occur in less than 0.1% pregnancies, with atrial flutter accounting for one-third of cases. Atrial flutter results from a reentrant circuit within the atrium with atrial rates in fetal atrial flutter ranging from 300 to 540 beats per minute. The fetal atrial flutter is most often an isolated finding; however, it may also be associated with maternal diabetes, neonatal macrosomia, cardiac rhabdomyoma, maternal substance use, Turner syndrome, congenital heart disease, and the presence of accessory pathways. The majority of cases of atrial flutter in the neonatal period are isolated; however, only a few cases of recurrent atrial flutter have been described. Methods: This is a single-institution, retrospective chart review of neonates with recurrent atrial flutter. Results: Four neonates with recurrent atrial flutter were identified, each linked either to a correctable trigger or to an underlying substrate, guiding individualized therapy. When no clear trigger was present, antiarrhythmic medication was required. Conclusions: These cases highlight the importance of the recognition of potential triggers of recurrent neonatal atrial flutter, tailoring therapy accordingly and considering antiarrhythmic agents when necessary.