Korean Circ J.  2018 Feb;48(2):148-158. 10.4070/kcj.2017.0179.

The Complexity of Pediatric Multifocal Atrial Tachycardia and Its Prognostic Factors

• Baek SM
• Chung H
• Song MK
• Bae EJ
• Kim GB
• Noh CI

• KMID: 2403162
• DOI: http://doi.org/10.4070/kcj.2017.0179

Abstract

BACKGROUND AND OBJECTIVES
Multifocal atrial tachycardia (MAT), in general, has a favorable outcome. However, there are insufficient data regarding MAT in a pediatric population. This study sought to determine the clinical course of MAT and identify potential prognostic factors.
METHODS
The medical records of MAT patients from 1997-2015 were reviewed. The arrhythmia control rate and factors for unfavorable outcomes were assessed and compared to those in the literature.
RESULTS
Of the 33 included patients (19 boys and 14 girls), 27 were infants less than 1 year of age. The median age at diagnosis was 1.7 months (range, 0 day to 14 years). Fourteen (42%) patients had structural heart disease. Eight (24%) patients had lung disease and 6 (18%) had a syndromic diagnosis belonging to RASopathy. Two patients developed polymorphic ventricular tachycardia, in whom genetic analysis confirmed the presence of the RyR2 mutation several years later. MAT was controlled in 26 patients (84%) within 3.9 months (median; range, 16 days-18.4 years) using an average of 2.4 medications. There were 3 cases of cardiopulmonary mortality. The arrhythmia control rate was higher in the infant group (85%) than in the non-infant group (67%), although this trend was not statistically significant. There was a significantly lower rate of unfavorable outcomes in the idiopathic infant group (n=11) than in the other groups (p=0.008). Considering the findings of previous studies, the mortality rate was significantly higher in patients with structural heart disease than in patients without (21% vs. 5%, p=0.01).
CONCLUSIONS
MAT usually affects infants and has a favorable prognosis, particularly in the idiopathic infant group. However, in the presence of other comorbidities, MAT may have a variable clinical course.

Keyword

Supraventricular tachycardias; Atrial fibrillation; Atrial flutter

MeSH Terms

Arrhythmias, Cardiac
Atrial Fibrillation
Atrial Flutter
Comorbidity
Diagnosis
Heart Diseases
Humans
Infant
Lung Diseases
Medical Records
Mortality
Prognosis
Ryanodine Receptor Calcium Release Channel
Tachycardia*
Tachycardia, Supraventricular
Tachycardia, Ventricular
Ryanodine Receptor Calcium Release Channel

Figure

• 

  Figure 1 Holter monitoring of multifocal atrial tachycardia showed irregular narrow-QRS tachycardia with aberrantly conducted wide QRS complexes (arrows) and multiple morphologically distinct P-waves with variable P-R intervals.

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