Atrial Ectopic Tachycardia in Infant

Yoon, Myung Ja; Noh, Chung Il

Abstract

PURPOSE: Atrial ectopic tachycardia (AET) in older children and adult is characterized by being chronic, incessant and intractable. However, the nature of infantile AET is not defined yet. The purpose of this study was to evaluate our experience of infantile AET.
METHODS
We retrospectively reviewed the medical records of 13 infants (mean onset age, 2.8 +/- 2.3 months) diagnosed at Seoul National University Children's Hospital from June, 1988 to June, 1996. Multifocal atrial tachycardia (AT) and postoperative AT were excluded.
RESULTS
AET was presented with congestive heart failure in 8, fast heart rate in 4 and associated cardiac defect in 1. During tachycardia, atrial rates ranged 150-300 beats/min (mean +/- SD, 214 +/- 45 beats/min). Four had associated cardiac anomalies: atrial septal defects in 3, multiple cardiac tumor associated with tuberous sclerosis in 1. All infants with AET were received medical therapy: digoxin (D) only (4), D+beta-blocker (1), D+amiodarone (4), D+flecainide (3), D+amiodarone+flecainide+beta-blocker (1). Conventional drug with digoxin was partially effective. In intractable 7 cases, combination of D, amiodarone and/or class Ic drug (flecainide) was necessary to control AET. This medical regimen suppressed AET in all. During follow up (mean +/- SD, 37.1 +/- 15.8 months), all except 1 recovered from AET. In 1 with large atrial septal defect, AET could be controlled only after operation. A case died of sepsis.
CONCLUSION
In this study, infantile AET showed good prognosis and resolved during follow up. Medical management was possible in all cases. However, proper selection and combination of complex antiarrhythmic drug, including amiodarone and class Ic drugs were necessary to control AET in almost all the cases.