Article Text

NEONATAL ATRIAL FLUTTER MANAGEMENT: PLACE OF ELECTRICAL CARDIOVERSION
  1. A BenHamad1,
  2. H BenAmar1,
  3. M Sahnoun2,
  4. L Trigui1,
  5. N Hmida1,
  6. R Regaieg1,
  7. A Gargouri1,
  8. A Rekik1
  1. 1Department of Neonatology, Hedi Chaker Hospital, Sfax, Tunisia
  2. 2Department of Cardiology, Hedi Chaker Hospital, Sfax, Tunisia

Abstract

Neonatal atrial flutter is an atrial activity that is regular and rapid (up to 350–450 bpm).

We report the history of a full-term newborn. Antenatal echocardiography had diagnosed an atrial flutter. Delivery was carried out by caesarean section. In the check up, the newborn had a heart murmur, tachycardia between 190 and 230 bpm, polypnoea and good femoral pulse.

Electrocardiogram showed an atrial flutter with ventricular extrasystole. Echocardiography showed pulmonary stenosis with high pressure in the right ventricle, tricuspid insufficiency and right-to-left shunt in atria. Treatment with ventilation assistance, amiodarone and furosemide was immediately started. Sinus rhythm return was successfully obtained by cardioversion practised after 4 days. Pulmonary valve dilatation was carried out by the percutaneous approach with “Tayshak balloon”.

The neonatal prognosis is excellent if early management is undertaken. Cardioversion is the optimal treatment when arrhythmia is not haemodynamically tolerated. In other cases, third-class antiarrhythmetic agents such as amiodarone are indicated.

The diagnosis of such arrhythmia in the antenatal period incites research of aetiologies and starting treatment as soon as possible.

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