successful treatment of atrial flutter with propafenone and synchronized cardioversion in a newborn
TRANSCRIPT
SCIENTIFIC LETTER
Successful Treatment of Atrial Flutter with Propafenoneand Synchronized Cardioversion in a Newborn
Murat Konak & Hayrullah Alp & Nuriye Tarakçı &Tamer Baysal & Rahmi Örs
Received: 26 June 2013 /Accepted: 8 August 2013 /Published online: 15 September 2013# Dr. K C Chaudhuri Foundation 2013
To the Editor : Atrial Flutter (AF) is a rare but potentially lethalarrhythmia. It’s characterized by a rapid regular atrial rate(300–600 bpm), accompanied by varying degrees of AV block[1]. It’s often associated with serious complications such ascongestive heart failure, fetal hydrops and neurological dam-age [1–3]. Propafenone hydrochloride is a class IC antiar-rhythmic agent which has been shown to be highly effectivein the treatment of supraventricular and ventricular arrhyth-mias [4]. A newborn, born at 34 wk gestation presented withatrial flutter. Postnatal evaluation confirmed an irregular car-diac rhythm at rate of 210 beats/min. An ECG revealedsupraventricular tachycardia with a rate of 220/min. Echocar-diographic evaluation revealed pulmonary hypertension witha 40 mmHg gradient of tricuspid valve regurgitation andshowed the absence of structural heart disease. Initially, aden-osine was administered to the patient and an ECG showedtypical AF waves (Fig. 1a), with 3:1 blocked atrioventricularconduction (atrial rate of 320/min and a ventricular rate of107/min) (Fig. 1b). Amiodarone was administered whichfailed to convert the flutter. So, synchronized cardioversionwas attempted with 3 joules (1.4 J/kg) and sinus rhythm wasrestored. However, AF restarted after 6 h and synchronizedcardioversion with 3 joules was required four times intermit-tently during 2 d period. Sinus rhythm was not restored withall these treatments and propafenone at a dose of 10 mg/kg/dwas started. Although the patient’s ventricular rate was 120–130/min, AF 2/1 block were reverted to atrial tachycardia.Following increased dosage of propafenon (20 mg/kg/d),sinus rhythm was restored, with no recurrence. During the
three months of follow-up period with oral propafenone, norecurrence has been observed.
In the present case, propafenone has been found to be aneffective medication after the fourth cardioversion inmaintaining sinus rhythm. Also, multiple repeated synchro-nized cardioversions with an energy of 1.4 J/kg were found tobe safe for the newborn.
Fig. 1 a An electrocardiogrammonitor showing saw-tooth flutter wavesafter a dose of 100 mcg/kg adenosine administration b DI, DII and DIIIleads of electrocardiogram showing AF with 3:1 atrioventricular conduc-tion at a mean ventricular rate of 107 bpm
M. Konak (*) :N. Tarakçı :R. ÖrsDepartment of Neonatology, Meram School of Medicine Hospital,Necmettin Erbakan University, Konya 42080, Turkeye-mail: [email protected]
H. Alp : T. BaysalDepartment of Pediatric Cardiology, Meram School of MedicineHospital, Necmettin Erbakan University, Konya, Turkey
Indian J Pediatr (April 2014) 81(4):413–414DOI 10.1007/s12098-013-1224-3
References
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2. Jat KR, Lodha R, Kabra SK. Arrhythmias in children. Indian J Pediatr.2011;78:211–8.
3. Ceresnak SR, Starc TJ, Hordof AJ, Pass RH, BonneyWJ, Liberman L.Elevated ımpedance during cardioversion in neonates with atrial flut-ter. Pediatr Cardiol. 2009;30:436–40.
4. Paul T, Janoušek J. New antiarrhythmic drugs in pediatric use:Propafenone. Pediatr Cardiol. 1994;15:190–7.
414 Indian J Pediatr (April 2014) 81(4):413–414