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

Pediatric Heart Institute, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.

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.

This article has been cited by other articles:

				The International Liaison Committee on Resuscitati The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Pediatric Basic and Advanced Life Support Pediatrics, May 1, 2006; 117(5): e955 - e977. [Abstract] [Full Text] [PDF]

				D S Kothari and J R Skinner Neonatal tachycardias: an update. Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2006; 91(2): F136 - F144. [Abstract] [Full Text] [PDF]

				Part 6: Pediatric Basic and Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-73 - III-90. [Full Text] [PDF]

				J. C. Salerno, N. J. Kertesz, R. A. Friedman, and A. L. Fenrich Jr Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children <3 or >=3 years of age J. Am. Coll. Cardiol., February 4, 2004; 43(3): 438 - 444. [Abstract] [Full Text] [PDF]

				J. F. Price, N. J. Kertesz, C. S. Snyder, R. A. Friedman, and A. L. Fenrich Jr Flecainide and sotalol: a new combination therapy for refractory supraventricular tachycardia in children <1 year of age J. Am. Coll. Cardiol., February 6, 2002; 39(3): 517 - 520. [Abstract] [Full Text] [PDF]

				P. A. Chiale, D. A. Franco, H. O. Selva, C. A. Militello, and M. V. Elizari Lidocaine-sensitive atrial tachycardia: Lidocaine-sensitive, rate-related, repetitive atrial tachycardia: a new arrhythmogenic syndrome J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1637 - 1645. [Abstract] [Full Text] [PDF]

				A.-M. Poutiainen, M. J. Koistinen, K. E. J. Airaksinen, E. K. Hartikainen, R. V. J. Kettunen, J. E. Karjalainen, and H. V. Huikuri Prevalence and natural course of ectopic atrial tachycardia Eur. Heart J., May 1, 1999; 20(9): 694 - 700. [Abstract] [PDF]

				E Jaeggi, J C Fouron, A Fournier, N van Doesburg, S P Drblik, and F Proulx Ventriculo-atrial time interval measured on M mode echocardiography: a determining element in diagnosis, treatment, and prognosis of fetal supraventricular tachycardia Heart, June 1, 1998; 79(6): 582 - 587. [Abstract] [Full Text]