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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- 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