Atrial tachycardias in children
- Ronald J Kanter, MD
Ronald J Kanter, MD
- Director, Electrophysiology
- Miami Children's Hospital
Atrial tachycardia (AT) is a non-sinus arrhythmia that results in a heart rate greater than the 95th percentile for age and does not require the atrioventricular (AV) junction, accessory pathways, or ventricular tissue for initiation and maintenance of the elevated heart rate. Atrial fibrillation and atrial flutter, although fulfilling this definition, are usually not included in the designation of AT and are typically identified as specific entities.
Atrial tachyarrhythmias are most commonly seen in children with congenital heart disease (CHD) in whom cardiac surgery has been performed; they also occur in children without cardiac surgery or CHD, and may result in significant morbidity.
ATs, including atrial flutter and fibrillation, in children not having undergone heart surgery will be reviewed here. Atrial arrhythmias in patients with CHD are discussed separately. (See "Atrial arrhythmias (including AV block) in congenital heart disease".)
AT is a subset of supraventricular tachycardia (SVT). SVT is a broad group of tachycardic disorders that includes any non-sinus rapid rhythm that arises from structures above the bundle branches, including the atrium.
AT can be divided into several different tachyarrhythmias based on the P wave phenotype on electrocardiogram (ECG), whether a single or multiple foci are involved in the origin of the tachycardia, and the frequency and duration of tachycardia (ie, sporadic/paroxysmal, frequently recurrent, or persistent tachycardia). The tachycardia mechanism (macroreentry, microreentry, enhanced automaticity, and triggered) only loosely correlates with this schema and should be avoided as part of the classification nomenclature unless the mechanism is clearly known. For completeness sake, atrial flutter and fibrillation are also discussed in this review.
- Ko JK, Deal BJ, Strasburger JF, Benson DW Jr. Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am J Cardiol 1992; 69:1028.
- Poutiainen AM, Koistinen MJ, Airaksinen KE, et al. Prevalence and natural course of ectopic atrial tachycardia. Eur Heart J 1999; 20:694.
- Moore JP, Patel PA, Shannon KM, et al. Predictors of myocardial recovery in pediatric tachycardia-induced cardiomyopathy. Heart Rhythm 2014; 11:1163.
- Fishberger SB, Colan SD, Saul JP, et al. Myocardial mechanics before and after ablation of chronic tachycardia. Pacing Clin Electrophysiol 1996; 19:42.
- Tomita M, Ikeguchi S, Kagawa K, et al. Serial histopathologic myocardial findings in a patient with ectopic atrial tachycardia-induced cardiomyopathy. J Cardiol 1997; 29:37.
- Wang JN, Wu JM, Tsai YC, Lin CS. Ectopic atrial tachycardia in children. J Formos Med Assoc 2000; 99:766.
- Donnerstein RL, Berg RA, Shehab Z, Ovadia M. Complex atrial tachycardias and respiratory syncytial virus infections in infants. J Pediatr 1994; 125:23.
- Koca S, Topaloglu S, Cay S, Pac A. Electroanatomic mapping-guided radiofrequency ablation of adenosine sensitive incessant focal atrial tachycardia originating from the non-coronary aortic cusp in a child. Indian Pacing Electrophysiol J 2014; 14:258.
- Bauersfeld U, Gow RM, Hamilton RM, Izukawa T. Treatment of atrial ectopic tachycardia in infants < 6 months old. Am Heart J 1995; 129:1145.
- Salerno JC, Kertesz NJ, Friedman RA, Fenrich AL Jr. Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children < 3 or > or =3 years of age. J Am Coll Cardiol 2004; 43:438.
- Mehta AV, Sanchez GR, Sacks EJ, et al. Ectopic automatic atrial tachycardia in children: clinical characteristics, management and follow-up. J Am Coll Cardiol 1988; 11:379.
- Naheed ZJ, Strasburger JF, Benson DW Jr, Deal BJ. Natural history and management strategies of automatic atrial tachycardia in children. Am J Cardiol 1995; 75:405.
- Kang KT, Etheridge SP, Kantoch MJ, et al. Current management of focal atrial tachycardia in children: a multicenter experience. Circ Arrhythm Electrophysiol 2014; 7:664.
- Farooki ZQ, Green EW. Multifocal atrial tachycardia in two neonates. Br Heart J 1977; 39:872.
- Salim MA, Case CL, Gillette PC. Chaotic atrial tachycardia in children. Am Heart J 1995; 129:831.
- Fish FA, Mehta AV, Johns JA. Characteristics and management of chaotic atrial tachycardia of infancy. Am J Cardiol 1996; 78:1052.
- Bradley DJ, Fischbach PS, Law IH, et al. The clinical course of multifocal atrial tachycardia in infants and children. J Am Coll Cardiol 2001; 38:401.
- Demir T, Ergül Y, Akdeniz C, Tuzcu V. Electroanatomic mapping-guided radiofrequency ablation of multifocal atrial tachycardia in a child. Anadolu Kardiyol Derg 2013; 13:391.
- Shah SS, Hellenbrand WE, Gallagher PG. Atrial flutter complicating neonatal Coxsackie B2 myocarditis. Pediatr Cardiol 1998; 19:185.
- Till J, Wren C. Atrial flutter in the fetus and young infant: an association with accessory connections. Br Heart J 1992; 67:80.
- Hayes CJ, Gersony WM. Arrhythmias after the Mustard operation for transposition of the great arteries: a long-term study. J Am Coll Cardiol 1986; 7:133.
- Gewillig M, Cullen S, Mertens B, et al. Risk factors for arrhythmia and death after Mustard operation for simple transposition of the great arteries. Circulation 1991; 84:III187.
- Garson A Jr, Bink-Boelkens M, Hesslein PS, et al. Atrial flutter in the young: a collaborative study of 380 cases. J Am Coll Cardiol 1985; 6:871.
- Flinn CJ, Wolff GS, Campbell RM, et al. Natural history of supraventricular rhythms in 182 children following the Mustard operation. J Am Coll Cardiol 1983; 1:613.
- Radford DJ, Izukawa T. Atrial fibrillation in children. Pediatrics 1977; 59:250.
- Kirsh JA, Walsh EP, Triedman JK. Prevalence of and risk factors for atrial fibrillation and intra-atrial reentrant tachycardia among patients with congenital heart disease. Am J Cardiol 2002; 90:338.
- Ceresnak SR, Liberman L, Silver ES, et al. Lone atrial fibrillation in the young - perhaps not so "lone"? J Pediatr 2013; 162:827.
- Bertram H, Paul T, Beyer F, Kallfelz HC. Familial idiopathic atrial fibrillation with bradyarrhythmia. Eur J Pediatr 1996; 155:7.
- Tikanoja T, Kirkinen P, Nikolajev K, et al. Familial atrial fibrillation with fetal onset. Heart 1998; 79:195.
- Brugada R, Tapscott T, Czernuszewicz GZ, et al. Identification of a genetic locus for familial atrial fibrillation. N Engl J Med 1997; 336:905.
- Bisset GS 3rd, Seigel SF, Gaum WE, Kaplan S. Chaotic atrial tachycardia in childhood. Am Heart J 1981; 101:268.
- Liberthson RR, Colan SD. Multifocal or chaotic atrial rhythm: report of nine infants, delineation of clinical course and management, and review of the literature. Pediatr Cardiol 1982; 2:179.
- Gelb BD, Garson A Jr. Noninvasive discrimination of right atrial ectopic tachycardia from sinus tachycardia in "dilated cardiomyopathy". Am Heart J 1990; 120:886.
- Heusch A, Kramer HH, Krogmann ON, et al. Clinical experience with propafenone for cardiac arrhythmias in the young. Eur Heart J 1994; 15:1050.
- Janousek J, Paul T. Safety of oral propafenone in the treatment of arrhythmias in infants and children (European retrospective multicenter study). Working Group on Pediatric Arrhythmias and Electrophysiology of the Association of European Pediatric Cardiologists. Am J Cardiol 1998; 81:1121.
- Celiker A, Ozer S, Ozme S, et al. Experience with propafenone for the treatment of cardiac arrhythmias in children. Turk J Pediatr 1990; 32:85.
- Perry JC, McQuinn RL, Smith RT Jr, et al. Flecainide acetate for resistant arrhythmias in the young: efficacy and pharmacokinetics. J Am Coll Cardiol 1989; 14:185.
- Evans VL, Garson A Jr, Smith RT, et al. Ethmozine (moricizine HCl): a promising drug for "automatic" atrial ectopic tachycardia. Am J Cardiol 1987; 60:83F.
- Maragnès P, Tipple M, Fournier A. Effectiveness of oral sotalol for treatment of pediatric arrhythmias. Am J Cardiol 1992; 69:751.
- Ge H, Li X, Zhang Y, et al. [Clinical course and treatment of ectopic atrial tachycardia in 144 children]. Zhonghua Er Ke Za Zhi 2015; 53:214.
- Walsh EP, Saul JP, Hulse JE, et al. Transcatheter ablation of ectopic atrial tachycardia in young patients using radiofrequency current. Circulation 1992; 86:1138.
- Celiker A, Koçak G, Lenk MK, et al. Short- and intermediate-term efficacy of amiodarone in infants and children with cardiac arrhythmia. Turk J Pediatr 1997; 39:219.
- Houyel L, Fournier A, Davignon A. Successful treatment of chaotic atrial tachycardia with oral flecainide. Int J Cardiol 1990; 27:27.
- Reimer A, Paul T, Kallfelz HC. Efficacy and safety of intravenous and oral propafenone in pediatric cardiac dysrhythmias. Am J Cardiol 1991; 68:741.
- Bevilacqua LM, Rhee EK, Epstein MR, Triedman JK. Focal ablation of chaotic atrial rhythm in an infant with cardiomyopathy. J Cardiovasc Electrophysiol 2000; 11:577.
- Lisowski LA, Verheijen PM, Benatar AA, et al. Atrial flutter in the perinatal age group: diagnosis, management and outcome. J Am Coll Cardiol 2000; 35:771.
- Jaeggi E, Fouron JC, Drblik SP. Fetal atrial flutter: diagnosis, clinical features, treatment, and outcome. J Pediatr 1998; 132:335.
- Casey FA, McCrindle BW, Hamilton RM, Gow RM. Neonatal atrial flutter: significant early morbidity and excellent long-term prognosis. Am Heart J 1997; 133:302.
- Peng CC, Chen MR, Hou CJ, et al. Atrial flutter in the neonate and early infancy. Jpn Heart J 1998; 39:287.
- Drago F, Mazza A, Garibaldi S, et al. Isolated neonatal atrial flutter: clinical features, prognosis and therapy. G Ital Cardiol 1998; 28:365.
- Uerpairojkit B, Tanawattanacharoen S, Manotaya S, et al. Intrauterine therapy of fetal atrial flutter. J Obstet Gynaecol Res 1998; 24:135.
- Butto F, Dunnigan A, Overholt ED, et al. Transesophageal study of recurrent atrial tachycardia after atrial baffle procedures for complete transposition of the great arteries. Am J Cardiol 1986; 57:1356.
- Kugler JD, Danford DA, Houston KA, et al. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol 2002; 13:336.
- Torok RD, Wei B, Kanter RJ, et al. Thoracoscopic resection of the left atrial appendage after failed focal atrial tachycardia ablation. Ann Thorac Surg 2014; 97:1322.
- Infants and children
- CLINICAL FEATURES AND NATURAL HISTORY
- Frequency and duration
- - Sustained tachycardia
- - Paroxysmal (sporadic) tachycardia
- Specific disorders
- - Focal atrial tachycardia and atrial ectopic tachycardia
- - Chaotic atrial tachycardia
- - Atrial flutter and intraatrial reentry tachycardia
- - Atrial fibrillation
- Fetal diagnosis
- Other cardiac tests
- Fetal atrial tachycardia
- Acute management
- Chronic management
- - Focal atrial tachycardia (FAT) and atrial ectopic tachycardia (AET)
- - Chaotic atrial tachycardia (CAT)
- - Neonatal atrial flutter
- Radiofrequency catheter ablation
- SUMMARY AND RECOMMENDATIONS