Atrial flutter in the young: A collaborative study of 380 cases

Garson, Arthur; Bink‐Boelkens, Margreet Th.E.; Hesslein, Peter S.; Hordof, Allan J.; Keane, John F.; Neches, William H.; Porter, Co Burn J.

doi:10.1016/s0735-1097(85)80497-6

Cited by 308 publications

(103 citation statements)

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“…Atrial tachycardias are a leading source of morbidity and mortality in patients after Fontan-type procedures [6,7,11]. Among patients with RA-PA connection that was performed in the past, the proportion of patients with supraventricular arrhythmia at 20 years after the surgery may be as high as 50% [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…Occurrence of atrial tachycardia (AT) in a patient after the Fontan procedure may result in a significant worsening of the clinical status, often leading to the development or worsening of heart failure, syncope, or even death (Fig. 1) [6,7]. Persistent arrhythmia with rapid ventricular response may lead to impaired function of the single ventricle, and systolic and diastolic dysfunction of the single ventricle may in turn result in the development or worsening of the atrioventricular valve regurgitation.…”

Section: Introductionmentioning

confidence: 99%

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Atrial tachycardia ablation in patients with a functional single ventricle after the Fontan surgery

et al. 2016

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A b s t r a c tBackground: Atrial tachyarrhythmias are a leading source of morbidity and mortality after Fontan-type procedures and antiarrhythmic drug therapy is often ineffective in these patients. Aim:To evaluate short-and long-term outcomes of radiofrequency current ablation for atrial tachycardia (AT) in patients after the Fontan procedure, and to report clinical, electrophysiological and electroanatomical characteristics of these arrhythmias. Methods:We retrospectively analysed data obtained in 8 patients (5 males, 3 females) after the Fontan procedure who underwent ablation for AT between 2002 and 2013. In order to compare the clinical impact of arrhythmia before and after ablation, we used the modified arrhythmia score, ranging from 0 (no arrhythmia activity) to 12 (very severe arrhythmia). In all patients, electroanatomical mapping using the CARTO system was performed, allowing semiquantification of low-voltage (< 0.5 mV) areas and scars.Results: Seven patients had an atriopulmonary connection and 1 patient had an extracardiac conduit. The mean patient age was 9.4 ± 3.1 years at the time of the Fontan procedure and 26.2 ± 4.6 years at the time of the first ablation. A total of 18 ablations were performed with no complications, 1 to 4 (median 2.5) procedures per patient. In patients who had more than 1 ablation, the mean time from the first to the last procedure was 34.8 months (range 1-64 months). In individual patients, 1 to 4 (median 2.5) different ATs were observed, with the mean tachycardia cycle length of 334 ± 95 ms. In 6 patients, low-voltage area (< 0.5 mV) comprised 25-50% of the right atrium, and in two others it comprised 10-25% and < 10% of the right atrium, respectively. Seven procedures were fully successful (ablation of all ATs), 7 were partially successful (ablation of only some AT, including clinical arrhythmia, but not of all ATs) and 4 were unsuccessful (failed ablation of clinical AT). The mean procedural, fluoroscopy and ablation times were 176 ± 54.6, 13.7 ± 5.7 and 21.7 ± 11.9 min, respectively. Freedom from arrhythmia during the mean follow-up of 58.6 ± 46 months (range 11-127 months) since the last procedure was obtained in 4 patients. The median arrhythmia score after the last ablation was significantly reduced compared to baseline (4.5 vs. 8; p < 0.05).Conclusions: Catheter ablation of AT in patients after the Fontan procedure is safe but its acute and long-term efficacy is limited. Due to complex and extensive substrate, along with complex anatomy, recurrences are frequent and patients may require repeat ablation procedures. Suppression of arrhythmia is associated with an improved clinical status of the patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Atrial tachycardia ablation in patients with a functional single ventricle after the Fontan surgery

et al. 2016

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“…4 In the largest published study evaluating 380 children and young adults with atrial flutter, none were attributable to hyperthyroidism. 5 From a different perspective, review of several series of thyrotoxicosis in childhood encompassing 279 patients failed to identify any with atrial flutter. 6 -10 Serum thyroid hormone has direct and indirect effects on the heart.…”

Section: Discussionmentioning

confidence: 99%

Atrial Flutter: An Uncommon Pediatric Manifestation of Hyperthyroidism

Suarez¹,

Hare²,

Wexler³

et al. 1997

Pediatrics

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ABSTRACT. Objective. Atrial flutter is an uncommon arrhythmia in the pediatric population except for the immediate newborn period or following atrial repair of congenital heart disease. In children the diagnosis of atrial flutter may be difficult, attributable to rapid atrioventricular conduction and superimposition of flutter waves on QRS and T waves. Atrial flutter secondary to hyperthyroidism has been rarely reported in older adults, but there are no reports of children presenting with atrial flutter as the initial manifestation of hyperthyroidism.Case Report. We report an interesting case of hyperthyroidism in a 3-year-old presenting with congestive heart failure and atrial flutter with 1:1 atrioventricular conduction. The responses to adenosine administration and to cardioversion were unusual and ultimately helpful in suggesting the diagnosis of hyperthyroidism.Conclusion. When atrial flutter is encountered in a pediatric patient in whom there is 1:1 atrioventricular conduction, a lack of a response to adenosine, and persistent sinus tachycardia after cardioversion, the clinician should be alert to the possibility of thyrotoxicosis. Pediatrics 1997;100(2). URL: http://www.pediatrics.org/ cgi/content/full/100/2/e11; atrial flutter, hyperthyroidism, pediatric, adenosine.A trial flutter is an uncommon arrhythmia in the pediatric population. It is principally encountered in the newborn period or after atrial repair of congenital heart disease. Although hyperthyroidism is clearly known to be a cause of atrial flutter in older adults, 1,2 there are no reports of children presenting with atrial flutter as the initial manifestation of thyrotoxicosis.When children present with atrial flutter, the diagnosis is often difficult, attributable to rapid atrioventricular conduction and superimposition of flutter waves on QRS and T waves. The presence of hyperthyroidism would be expected to further affect these relationships. We report here an interesting case of thyrotoxicosis in a 3-year-old presenting with atrial flutter in whom the response to adenosine administration and to cardioversion were unusual and ultimately helpful in suggesting the diagnosis of thyrotoxicosis. CASE REPORTA 3-year-old black girl presented with an increased heart rate noted for 9 hours and decreased activity. She had a similar episode of "fast heart rate" 2 days previously. She had no history of fever, heat intolerance, neck pain, significant weight loss or hoarseness, but was extremely hyperactive. Her past medical history was only remarkable for scarlet fever treated with amoxicillin 2 months before admission. The family history was remarkable for a maternal aunt with an overactive thyroid and another cousin with insulin-dependent diabetes mellitus.On physical examination, she was 17.3 kg and had a regular heart rate of 275 beats/minute, respiratory rate of 66 breaths/ minute, blood pressure of 111/78 mm Hg, and a axillary temperature of 37.7°C. She had moderate retractions. There was a nontender, enlarged thyroid gland. The lung fields were c...

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“…Например, неосложненное исправление дефектов межпредсердной и межжелудочковой пере-городок связано с малой вероятностью возникнове-ния поздних послеоперационных аритмий [494]. Напротив, хорошо известно, что сложные восстано-вительные операции с остаточными нарушениями гемодинамики сопряжены с частыми приступами предсердных и желудочковых аритмий [495,496]. Хотя значение аритмий у этих пациентов остается противоречивым, желудочковые нарушения ритма высоких градаций в сочетании с желудочковой дис-функцией являются, по-видимому, показателем для выявления детей с увеличенным риском ВС [497,498].…”

Section: хм у детей с кардиоваскулярной патологиейunclassified