Why the study?
Atrial flutter is an uncommon arrhythmia causing severe morbidity such as heart failure or death in refractory cases, warranting investigation into neonatal clinical characteristics, treatment, long-term outcomes, and heart failure associations.
What are the clinical characteristics, treatments, and long-term outcomes of neonatal atrial flutter?
What are the clinical characteristics, treatments, and long-term outcomes of neonatal atrial flutter?
Neonates with atrial flutter and congestive heart failure have a higher risk of recurrence, though long-term outcomes after the neonatal period are excellent with no recurrences.
DC cardioversion remains preferred for neonatal atrial flutter; observational data support digoxin in refractory cases but leave practice implications open.
BACKGROUND: Atrial flutter is an uncommon arrhythmia that can cause severe morbidity, including heart failure and even death in refractory cases. This study investigated the clinical characteristics, treatment, and long-term outcomes of patients with neonatal atrial flutter and its association with heart failure. METHODS: We retrospectively reviewed atrial flutter cases observed in our center between 1999 and 2021 and analyzed the clinical characteristics, treatment, and recurrence according to the presence of heart failure. RESULTS: weeks, respectively. Twelve patients were diagnosed with atrial flutter on the first day of life. The median atrial and ventricular rates were 440/min, 220/min, respectively. Four patients exhibited congestive heart failure. Episodic recurrence was noted in five patients and occurred at a higher rate in patients with congestive heart failure (p = 0.004). Antiarrhythmic drugs for maintenance treatment were administered more often in patients with heart failure (p = 0.011). Initial treatment included direct current cardioversion (n = 9), digoxin (n = 4), and observation (n = 2). Four patients treated with cardioversion experienced recurrence during the neonatal period, and none of those treated with digoxin experienced recurrence. The median follow-up duration was 7 years, during which no atrial flutter recurrence was evident. CONCLUSION: Neonates with congestive heart failure had a higher recurrence of atrial flutter. Direct current cardioversion is the most reliable treatment for neonatal atrial flutter, whereas digoxin may be a viable treatment option in refractory and recurrent cases.
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Kim et al. (2023) studied this question.
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