Abstract
Many authorities recommend digoxin for one year for atrial flutter (AT.FL) in infants with normal structural hearts. To re-examine this recommendation the electrocardiogram, response to programmed extrastimulation, (PES) (n=3), and clinical course in six infants with AT.FL. alone were reviewed. AT.FL exhibited a regular sawtooth pattern with a cycle length of 148 msec (range: 130-160 msec). Age at diagnosis was 34 days (range: birth (n=4) to 180 days). There were two males and four females; all were initiallly treated with digoxin but only two converted to sinus rhythm. AT.FL resolved spontaneously in two, two were converted with atrial overdrive pacing. Post-conversion electrocardiogram demonstrated normal P wave axis, PR interval .14 sec (range: .12-.16 sec), P wave duration .08 sec, and P wave amplitude .23 mV (3 > .25 mV) at heart rate 142 bpm. Post-conversion atrial PES with burst pacing in three failed to initiate AT.FL and demonstrated normal atrial effective refractory periods (158 msec; range: 150-173 msec) and normal atrioventricular conduction system effective refractory periods (199 msec; range: 180-216 msec). Only two patients were maintained on digoxin, six months and one year after conversion. Follow-up was 5.5 years (1.5 - 18 years) without recurrence. These data suggest that AT.FL in infants without structural heart disease, following conversion, is self-limited and not easily inducible by extrastimulation. We conclude that infants with atrial flutter alone, following cardioversion, do not require chronic prophylaxis.
Article PDF
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Scott, W., Bromberg, B., Dick, M. et al. ATRIAL FLUTTER IN INFANCY: NO NEED FOR CHRONIC PROPHYLAXIS. Pediatr Res 21 (Suppl 4), 194 (1987). https://doi.org/10.1203/00006450-198704010-00169
Issue Date:
DOI: https://doi.org/10.1203/00006450-198704010-00169