Summary
An electrocardiographic classification of atrial tachycardia and its significance in children has not been reported. We reviewed the clinical histories and 12-lead surface electrocardiograms (ECG) of 21 children with atrial tachycardia. Atrial rate and P-wave axis were determined for each patient. Some patients had features of typical atrial flutter (AF). Tachycardia was classified by atrial rate <340/min or atrial rate >340/min.
Children with atrial tachycardia rate >340/min consistently responded to conservative treatment (digoxin and/or cardioversion) without recurrences (p<0.05 andp>0.025); whereas in children with atrial rate <340/min, only one case responded to conservative therapy. P-wave axis had no prognostic significance for either group. Additionally, high atrial rate (>340/min) during tachycardia was noted in early infancy, compared to older children and adults, and probably represents the function of age. Classification of atrial tachycardia by rate is clinically useful for planning therapy and predicting response in children.
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References
Allessie MA, Bonke FIM, Schopman FJG (1977) Circus movement in rabbit atrial muscle as a mechanism of tachycardia. III. The “leading circle” concept: a new model of circus movement in cardiac tissue without the involvement of an anatomical obstacle.Circ Res 41:9–18
Boineau JP (1985) Atrial flutter: a synthesis of concepts.Circulation 72:249–257
Boineau JP, Schuessler RB, Mooney CR, et al. (1980) Natural and evoked atrial flutter due to circus movement in dogs.Am J Cardiol 45:1167–1181
Campbell RM, Dick M II, Jenkins JM, et al. (1985) Atrial overdrive pacing for conversion of atrial flutter in children.Pediatrics 75:730–736
Casta A, Wolff GS, Mehta AV, Tamer DF, Pickoff AS, Gelband HC (1984) Induction of nonsustained atrial flutter by programmed atrial stimulation in children: incidence, mechanisms, and clinical implications.Am Heart J 107:444–448
Cohen SI, Koh D, Lau SH, Rosen KM, Damato AN (1977) P loops during common and uncommon atrial flutter in man.Br Heart J 39:173–180
Disertori M, Inama G, Vergara G, Guarnerio M, Favero AD, Furlanello F (1983) Evidence of a reentry circuit in the common type of atrial flutter in man.Circulation 67:434–440
DuBrow IW, Fisher EA, Amat-y-Leon F, et al. (1975) Comparison of cardiac refractory periods in children and adults.Circulation 51:485–491
DuBrow IW, Fisher EA, Denes P, Hastreiter AF (1976) The influence of age on cardiac refractory periods in man.Pediatr Res 10:135–139
Dunnigan A, Benson DW Jr, Benditt DG (1985) Atrial flutter in infancy: diagnosis, clinical features, and treatment.Pediatrics 75:725–729
Garson A Jr, Bink-Boelkens M, Hesslein PS, et al. (1985) Atrial flutter in the young: a collaborative study of 380 cases.J Am Coll Cardiol 6:871–878
Klein GJ, Guiraudon GM, Sharma AD, Milstein S (1986) Demonstration of macroreentry and feasibility of operative therapy in the common type of atrial flutter.Am J Cardiol 57:587–591
Leier CV, Meacham JA, Schaal SF (1978) Prolonged atrial conduction. A major predisposing factor for the development of atrial flutter.Circulation 57:213–216
Martin TC, Hernandez A (1982) Atrial flutter in infancy.J Pediatr 100:239–242
Moller JH, Davachi F, Anderson RC (1969) Atrial flutter in infancy.J Pediatr 75:643–651
Pickoff AS, Singh S, Flinn CJ, McCormack J, Stolfi A, Gelband HC (1985) Atrial vulnerability in the immature canine heart.Am J Cardiol 55:1402–1406
Rodriguez-Coronel A, Sueblingvong V, Hastreiter AR (1968) Clinical forms of atrial flutter in infancy.J Pediatr 73:69–76
Rowland TW, Mathew R, Chameides L, Keane JF (1978) Idiopathic atrial flutter in infancy: a review of eight cases.Pediatrics 61:52–56
Watson RM, Josephson ME (1980) Atrial flutter. I. Electrophysiologic substrates and modes of initiation and termination.Am J Cardiol 45:732–741
Wells JL, MacLean WAH, James TN, Waldo AL (1979) Characterization of atrial flutter. Studies in man after open heart surgery using fixed atrial electrodes.Circulation 60:665–673
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Mehta, A.V., Ewing, L.L. Atrial tachycardia in infants and children: Electrocardiographic classification and its significance. Pediatr Cardiol 14, 199–203 (1993). https://doi.org/10.1007/BF00795370
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DOI: https://doi.org/10.1007/BF00795370