Neonatal Med.  2022 Aug;29(3):97-104. 10.5385/nm.2022.29.3.97.

Neonatal Atrial Flutter: Clinical Characteristics of 14 Cases in a Single Center

• Park SH
• Lim G
• Oh KW
• Ko JK

• KMID: 2533091
• DOI: http://doi.org/10.5385/nm.2022.29.3.97

Abstract

Purpose
Atrial flutter is an uncommon arrhythmia in the neonatal period. This study aimed to describe the cause and clinical course of atrial flutter in neonates.
Methods
The medical records of 14 patients diagnosed with atrial flutter at Ulsan University Hospital Neonatal Intensive Care Unit (NICU) between March 2008 and August 2020 were reviewed retrospectively.
Results
All 14 cases occurred on the first day of birth. Of these, two were term infants, and 12 were preterm infants. Causes of atrial flutter included three cases of the umbilical venous catheter misplacement, one with a diabetic mother, and one ivolving atrial flutter after an intravenous aminophylline injection. Thirteen patients had structurally normal hearts with no congenital heart diseases. The patient, born to a diabetic mother, had an atrial septal defect and ventricular hypertrophy. Adenosine was administered first to differentiate it from paroxysmal supraventricular tachycardia. Synchronized cardioversion was attempted in 11 patients, while one received it after an esmolol injection that failed to convert to sinus rhythm. One patient had a recurrence after the intrusion of a peripherally inserted central catheter; however, atrial flutter disappeared after repositioning it. No patient had a recurrence after discharge.
Conclusion
Neonatal atrial flutter is a rare tachyarrhythmia with the risk factors often unknown; however, it could occur in structural heart disease, mispositioning of the umbilical venous catheter, and if the mother has diabetes. During umbilical venous catheterization, clinicians should be cautious and ensure appropriate monitoring of infants in the NICU as it may cause complications.

Keyword

Atrial flutter; Infant, newborn; Umbilical catheterization; Electric countershock

Figure

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  Figure 1. A 12-lead electrocardiogram of Case 1 shows a saw-tooth pattern of atrial flutter with 2:1 atrioventricular conduction in leads II, III, and aVF.

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  Figure 2. (A) Baseline 12-lead electrocardiogram of Case 10 demonstrates narrow QRS-tachycardia with a ventricular rate of 200 beats per minute. (B) A 12-lead electrocardiogram after adenosine injection shows atrial flutter of 462 beats per minute with variable atrioventricular conduction.

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  Figure 3. Chest radiograph of Case 13 demonstrating an umbilical venous catheter in the left atrium (white arrow: tip of umbilical catheter).

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