Ectopic automatic atrial tachycardia in children: Clinical characteristics, management and follow-up

Abstract

Ectopic automatic atrial tachycardia, an uncommon type of supraventricular tachycardia in children and adults, has been reported to be resistant to medical therapy, and surgical or cryoblation has been recommended. This report describes 10 infants and children (median age 6 months; range birth to 7.5 years) with automatic atrial tachycardia and their management and follow-up. Digoxin alone was unsuccessful in controlling tachycardia in all 10 patients but decreased the tachycardia rate by 5 to 20% in 8. Intravenous (0.1 mg/kg body weight per dose) and oral propranolol successfully suppressed tachycardia in three of five patients and oral propranolol successfully controlled tachycardia in two of five other patients. Class I antiarrhythmic agents--quinidine (three patients), procainamide (four patients) and phenytoin (three patients)--did not control tachycardia in any patients but made the tachycardia rate worse in three patients. Intravenous (5 mg/kg per dose) and oral amiodarone suppressed tachycardia in three of four patients and oral amiodarone suppressed it in another patient. Thus, intravenous propranolol and amiodarone were effective in acutely suppressing automatic ectopic atrial tachycardia and predicted the response to long-term oral therapy. One patient had persistent tachycardia after surgical ablation of the high right atrial ectopic focus, and another patient had unsuccessful catheter ablation of the high right atrial ectopic focus (25 J). During follow-up (10 to 28 months), ectopic atrial tachycardia resolved completely in four patients and was well controlled in four patients.

Current Management of Focal Atrial Tachycardia in Children

“…7,8 A variety of antiarrhythmic medications have been effective, although FAT is often resistant to pharmacological therapy. [7][8][9][10][11][12] Radiofrequency ablation (RFA) has been used successfully for definitive management.…”

Part 6: Advanced Cardiovascular Life Support : Section 5: Pharmacology I: Agents for Arrhythmias

“…Therefore, in patients at risk for systemic emboli, amiodarone is recommended only when other medications for rate control have proved ineffective or are contraindicated and the risk of possible pharmacological cardioversion is felt to be justified. Some studies have found that whereas amiodarone was effective for rate control, conversion to sinus rhythm was no greater with conventional doses of IV amiodarone than placebo or digitalis, [55][56][57][58][59][60][61][62][63][64][65][66][67]160 particularly in refractory AF and clinical shock. Because of this concern amiodarone should be reserved for use within the first 48 hours of arrhythmia onset 62,78 or in patients in whom other rate-control measures are ineffective or contraindicated.…”

“…Digitalis may be effective in slowing heart rate but not in terminating ectopic atrial arrhythmias. 59 Digitalis also has been associated with provoking ectopic atrial tachycardia. Other useful drugs for ectopic atrial tachycardia or MAT include amiodarone, 59,60,80 flecainide, 131,132 and propafenone.…”

“…59 Digitalis also has been associated with provoking ectopic atrial tachycardia. Other useful drugs for ectopic atrial tachycardia or MAT include amiodarone, 59,60,80 flecainide, 131,132 and propafenone. 133,134 Quinidine, procainamide, and phenytoin are not effective.…”

“…133,134 Quinidine, procainamide, and phenytoin are not effective. 59 In summary, synchronized electrical cardioversion is ineffective for the treatment of automatic atrial arrhythmias (Class III). In patients with preserved LV function, acceptable treatments include calcium channel blockers (Class IIb), ␤-blockers (Class IIb), digitalis (Class Indeterminate), amiodarone (Class IIb), intravenous flecainide (Class IIb), and IV propafenone (Class IIb).…”