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CLINICAL STUDY

The clinical course of multifocal atrial tachycardia in infants and children

David J. Bradley, MD^*, Peter S. Fischbach, MD^*, Ian H. Law, MD, Gerald A. Serwer, MD, FACC^* and Macdonald Dick, II, MD, FACC^*

^* University of Michigan Congenital Heart Center and the Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA

Manuscript received March 13, 2000; revised manuscript received April 16, 2001, accepted April 26, 2001.

Reprint requests and correspondence: Dr. Macdonald Dick II, L1249 Box 0204, Women’s Hospital, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0204
mdick{at}umich.edu

OBJECTIVES

This study outlines the clinical course, treatment and the late outcome of infants and children with multifocal atrial tachycardia (MAT).

BACKGROUND

Multifocal atrial tachycardia is defined by three distinct P-waveforms, irregular P-P intervals, isoelectric baseline between P-waves and rapid rate on an electrocardiogram. Several smaller prior reports have described pediatric patients with MAT, but their long-term outcome has not been fully assessed.

METHODS

The clinical records, echocardiograms and long-term follow-up of patients with MAT were reviewed and compared to previous reports of MAT.

RESULTS

Fourteen boys and seven girls (median age 1.8 months) presented with MAT. At diagnosis, six patients had respiratory illness, of whom two were critical. Ten were asymptomatic. Seven patients had structural heart disease (SHD), one of whom died. Four of 15 patients (27%) with echocardiograms had diminished ventricular function. Ventricular rates were 111 to 253 beats/min (mean 181 beats/min). Median duration of the arrhythmia was 4.9 months (mean 6.7 months). Electrical cardioversion was attempted in 4 patients without success and 15 patients received antiarrhythmic medication. Seventeen patients were followed for a mean of 60 months. Four patients were lost to follow-up. There were no late arrhythmias.

CONCLUSIONS

The majority of children with MAT are healthy infants under one year of age; a few may exhibit mild to life-threatening cardiorespiratory disease. Less often, MAT accompanies SHD. Mild ventricular dysfunction may be observed in the presence of MAT, but symptoms are few and resolution is generally complete. Response to antiarrhythmic agents is mixed, and cardioversion is of no avail. Finally, long-term cardiovascular and developmental outcome depends principally on underlying condition; for otherwise healthy children, it is excellent.

Abbreviations and Acronyms   ECG = electrocardiogram, electrocardiographic   HOCM = hypertrophic obstructive cardiomyopathy   MAT = multifocal atrial tachycardia   RSV = respiratory syncytial virus   SHD = structural heart disease   SVT = supraventricular tachycardia

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