Clinical recognition and treatment of atrial ectopic tachycardia in newborns.

QUESTIONS: Atrial ectopic tachycardia (AET) may be difficult to diagnose in neonates and treatment can be complex especially in case of severe heart failure. This study addresses the clinical recognition and drug therapy of AET in neonates.

METHODS

Retrospective chart and database review of neonates diagnosed with AET between 1994 and 2002.

RESULTS

AET was diagnosed in 19 neonates at a median age of 18 days (range 0-64). A paroxysmal AET pattern was seen in 10 and a permanent in 9 patients. Tachycardia in the foetal or neonatal period indicated an arrhythmia in 8 patients while 11 showed non-specific symptoms. Severely depressed ventricular dysfunction was observed in 2 patients necessitating cardiovascular resuscitation in 1. The mean maximum paroxysmal AET rate was 213 bpm (range 178-227). For permanent AET, the median mean heart rate was 169 bpm (153-185) and the mean maximum heart rate was 212 bpm (range 196-274). Antiarrhythmic class Ic and III drugs alone or as combination therapy controlled AET in all 18 treated neonates and ventricular dysfunctions resolved. Proarrhythmic drug side effects were seen in 1 patient under propafenone therapy.

CONCLUSIONS

AET in neonates is frequently recognised as paroxysmal or permanent tachycardia. Symptoms are often non-specific even though neonates and infants may develop severe ventricular dysfunction. A high degree of awareness is mandatory for neonatologists, paediatricians and primary care physicians to recognise AET in neonates. Class Ic and III antiarrhythmic drugs are effective in the treatment of neonatal AET. Monitoring for proarrhythmic drug side effects is mandatory.