Atrial automatic tachycardia in infancy and childhood

Abstract

Twenty-one cases (13 male, eight female) of atrial automatic tachycardia (AAT) assessed by standard and Holter-ECG in otherwise healthy infants and children have been documented. AAT was incessant in 12 patients, repetitive in seven, and of undetermined type in the remaining two. The frontal P wave axis suggested an ectopic focus in the high right atrium or right atrial appendage in 13 patients, in the low right atrium in one patient, and in the left atrium in seven patients. Thirteen out of 14 patients with the incessant or undetermined type of AAT were symptomatic, in contrast to only two of seven patients with the repetitive type. All patients were treated with between one and eight (median three) antiarrhythmic drugs. The most effective drug was amiodarone, followed by the class I C antiarrhythmic drugs, propafenone and flecainide. At present, all patients are alive 4 months to 21 years (median 2.5 years) after diagnosis of AAT. Twelve patients are in sinus rhythm, five of them without any medication. Nine patients still have AAT, which, however, is repetitive or intermittent in all but one. In conclusion, AAT is an unusual, and in its incessant form often severely symptomatic arrhythmia, which is resistant to conventional antiarrhythmic medication. However, amiodarone and class I C antiarrhythmic drugs are frequently effective. Since medical treatment with these drugs is often successful, and AAT may resolve completely, a conservative approach is indicated in many cases.

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.…”

Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children <3 or ≥3 years of age

“…Historically, AET has been resistant to pharmacologic therapy (2)(3)(4). More recently, limited treatment success has been reported with class Ic and class III antiarrhythmics (5)(6)(7). The natural history of AET includes possible progression to congestive heart failure (2,4), and it represents one of the few reversible etiologies of cardiomyopathy (4,8,9).…”

Atrial tachycardia

“…In another study [3], flecainide was successful in 62% of eight pediatric patients with atrial ectopic tachycardia. Others [6,7] have reported similar efficacy for propafenone (class IC) and sotalol (class III). • Few data exist on the relative efficacy of the various antiarrhythmic drugs (Table 2).…”

“…Available therapies for atrial tachycardia include th use of antiarrhythmic drugs [1•,2••, [3][4][5][6][7], radiofrequency catheter ablation [8•,9••,10], and antiarrhythmic surgery [11•,12]. The initial treatment of choice has traditionally been antiarrhythmic drugs, but the efficacy of these drugs is modest at best and remains poorly defined.…”

“…The class IA, IC, and III drugs have direct effects on atrial electrophysiology and thus may prevent recurrence of atrial tachycardia. In reported studies [3][4][5][6][7], drug efficacy has ranged from 30% to 60%, but data on long-term success are scanty. Therefore, drug selection remains an empirical process based primarily on the side-effect and safety profiles of the various antiarrhythmic drugs.…”