Ewha Med J.  2017 Jul;40(3):140-142. 10.12771/emj.2017.40.3.140.

Intractable Atrial Flutter Successfully Treated with Flecainide and Propranolol in a Premature Infant

• Lee MJ
• Ahn SH
• Kim JH
• Kim SY
• Ban JE

• KMID: 2386392
• DOI: http://doi.org/10.12771/emj.2017.40.3.140

Abstract

Although Atrial flutter (AFL) in newborn infant with normal cardiac anatomy has benign clinical course, an intractable AFL is associated with an increased risk of development of heart failure and sudden death, and is still difficult to manage. It requires multiple external electrical cardioversions, and it shows a poor response to antiarrhythmic drug therapy. We report a case of a premature infant with an intractable AFL, which we successfully treated with oral flecainide and propranolol in spite of recurred AFL. A 1-month-old, 34-week gestation, premature baby presented with an irregular heart beat and irritability. An AFL with 2:1 atrioventricular conduction was documented. Because of the intractable AFL, repeated electrical cardioversion and amiodarone were continued for 14 days. However, amiodarone was discontinued in favour of flecainide and propranolol because of the recurrent AFL and newly developed transient hypothyroidism. During 1-year follow-up period, in which oral flecainide and propranolol were continued, no AFL was observed.

Keyword

Atrial flutter; Premature infant; Flecainide

MeSH Terms

Amiodarone
Atrial Flutter*
Death, Sudden
Drug Therapy
Electric Countershock
Flecainide*
Follow-Up Studies
Heart
Heart Failure
Humans
Hypothyroidism
Infant, Newborn
Infant, Premature*
Pregnancy
Propranolol*
Amiodarone
Flecainide
Propranolol

Figure

• 

  Fig. 1 A baseline 12-lead surface electrocardiogram. Premature atrial complexes (arrowhead) with non-conduction (arrow) and aberrant conduction (asterisk) are shown. aVR, augmented vector right; aVL, augmented vector left; aVF, augmented vector foot.

• 

  Fig. 2 Atrial flutter on an electrocardiogram. (A) A rhythm strip electrocardiogram showed narrow QRS tachycardia, with a ventricular rate of 198 beats/min. Atrial flutter with 2:1 atrioventricular conduction was documented on 12-lead electrocardiogram. (B) After the adenosine injection, a 12-lead surface electrocardiogram showed atrial flutter, with variable atrioventricular conduction and an atrial rate of 300 beats/min. AVR, augmented vector right; AVL, augmented vector left; AVF, augmented vector foot.

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