14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-48

Atrial ectopic tachycardia in infancy

Luciano De Simone, Simone Pratesi*, Iva Pollini, Silvia Favilli, Adriano Manetti.
Cardiology Unit, *Neonatal Intensive Care Unit, Meyer Children’s Hospital, Florence, Italy

Abstract

We present three cases of AET occuring in infancy. First patient was observed at birth because of a typical AET (ventricular rate 200/min). Sinus rythm was initially obtained by oral administration of amiodarone (5 mg/kg/die), and later by sotalol (4 mg/kg/die p.o.). At the age of four, because of atrial fibrillation, she underwent DC shock; an association of amiodarone (10 mg/kg/die p.o.) and nadolol (2 mg/kg/die p.o.) has been effective in preventing relapses.

Second patient presented at 10 months with cardiovascular collapse, EKG showing a rythmic tachycardia (300 bpm). After a DC shock an AET with AV block of variable grade was observed. After several attempts with class I and class III antiarrhythmic agents, the association of fleicainide (100 mg/m²/die) and nadolol (2 mg/kg) has been mantaining sinus rythm for 18 months. Now the patient is at sinus rithm without therapy.

Third patient was observed at 20 days for tachypnea, failure to thrive, gallop rythm and 2D-echo findings of dilated cardiomiopathy, with EKG showing an incessant AET (200 bpm). The arrhythmia was successfully treated with nadolol (1 mg/kg/die) and flecainide (150 mg/m²/die).

In conclusion: 1) AET may start in the first year of life and even in the neonate, with symptoms of cardiac failure or cardiogenic shock; 2) in our experience the association of class III or class Ic agents together with b-blockers has been safe and effective in mantaining a stable sinus rythm; 3) although radiofrequency ablation has been reported to be successful in suppressing the arrhythmia, the still limited experience in the first year of life suggests a more conservative approach.

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