Neonatal arrhythmias

Neonatal arrhythmias

Neonatal arrhythmias:

Neonatal atrial flutter

Often detected as “fetal distress” and can lead to unnecessary termination of labour. Atrial rate is often in the range of 400. Ventricular rates are in the range of 230. Fastest ventricular conduction in one series was 333. Median time of resolution is 5 days. Most often digoxin is used in the treatment and beta blockers are probably good. DC cardioversion, amiodarone or flecainide can also be used. Neonatal atrial flutter is less likely to recur after DC cardioversion, though cardioversion is being attempted less often.

Permanent junctional reentrant tachycardia (PJRT)

Associated with poor ventricular function and recurrence is practically 100%. Amiodarone alone seldom suffices and needs combination with flecainide. There is an interaction between milk and flecainide which has to be taken care of by appropriate timing of the administration. Ablation may have to be resorted in resistant cases. While planning to withdraw drugs, it may be better to switch on the digoxin and beta blocker before final withdrawal of drugs. This is usually done after a period of about 6 months.

Chaotic atrial rhythm or multifocal atrial tachycardia (MAT)

Persistent arrhythmia often difficult to treat and often associated with dilated cardiomyopathy. Treated with amiodarone, flecainide or DC cardioversion.

Calcium channel blockers are seldom used in the first two years of life. They can cause collapse on acute use and if they are being used chronically, adding beta blockers in a situation of recurrence is likely to be dangerous.