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Case Reports
. 2023 Oct 9;49(1):137.
doi: 10.1186/s13052-023-01542-4.

The diagnostic and therapeutic challenge of atrial flutter in children: a case report

Angelica De Nigris #  1 , Mattia Arenella #  2 , Giangiacomo Di Nardo  3 , Giovanni Maria Di Marco  3 , Annunziata Mormile  3 , Daria Lauretta  3 , Caterina De Simone  4 , Angela Pepe  5 , Rosaria Cosimi  3 , Rossella Vastarella  3 , Antonietta Giannattasio  6 , Giovanni Salomone  5 , Silverio Perrotta  2 , Speranza Cioffi  2 , Pierluigi Marzuillo  2 , Vincenzo Tipo  6 , Luigi Martemucci  7
Affiliations
Case Reports

The diagnostic and therapeutic challenge of atrial flutter in children: a case report

Angelica De Nigris et al. Ital J Pediatr. .

Abstract

Background: Palpitations represent a common cause for consultation in the pediatric Emergency Department (ED). Unlike adults, palpitations in children are less frequently dependent from the heart, recognizing other causes.

Case presentation: A 11-year-old male came to our pediatric ED for epigastric pain, vomiting and palpitations. During the previous 6 month the patient was affected by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus). Electrocardiogram (ECG) revealed supraventricular tachycardia. Therefore, adenosine was administered unsuccessfully. The administration of adenosine, however, allowed us to make diagnosis of atypical atrial flutter. Multiple attempts at both electrical cardioversion, transesophageal atrial overdrive, and drug monotherapy were unsuccessful in our patient. Consequently, a triple therapy with amiodarone, flecainide, and beta-blocker was gradually designed to control the arrhythmic pattern with the restoration of a left upper atrial rhythm. There was not any evidence of sinus rhythm in the patient clinical history.

Conclusions: The present study underlines the rarity of this type of dysrhythmia in childhood and the difficulties in diagnosis and management, above all in a patient who has never showed sinus rhythm. Raising awareness of all available treatment options is essential for a better management of dysrhythmia in children.

Keywords: Atrial flutter; Children; Dysrhythmia; Left upper atrial rhythm; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Atypical atrial flutter. The electrocardiogram shows the atypical atrial flutter (AFL) revealed after the administration of adenosine
Fig. 2
Fig. 2
Basal electrocardiogram pattern. The electrocardiogram shows the basal pattern of the patient characterized by a stable upper left atrial rhythm
Fig. 3
Fig. 3
Therapeutic management step by step
See this image and copyright information in PMC

References

    1. Rivera RF, Chambers P, Ceresnak SR. Evaluation of children with palpitation. Clin Pediatr Emerg Med. 2011;12:278–9. doi: 10.1016/j.cpem.2011.09.002. - DOI
    1. De Nigris A, Pepe A, Di Nardo G, Giannattasio A, Pagano A, D’Anna C, et al. Brugada Pattern in a child with severe SARS-CoV-2 related multisystem inflammatory syndrome. Pediatr Rep. 2021;13:504–10. doi: 10.3390/pediatric13030058. - DOI - PMC - PubMed
    1. Di Marco GM, De Nigris A, Pepe A, Pagano A, Di Nardo G, Tipo V. Ivabradine-flecainide as breakthrough drug combination for congenital junctional ectopic tachycardia: a Case Report and Literature Review. Pediatr Rep. 2021;13:624–31. doi: 10.3390/pediatric13040074. - DOI - PMC - PubMed
    1. Sacchetti A, Moyer V, Baricella R, Cameron J, Moakes ME. Primary cardiac arrhythmias in children. Pediatr Emerg Care. 1999;15:95–8. doi: 10.1097/00006565-199904000-00004. - DOI - PubMed
    1. Krapp M, Kohl T, Simpson JM, Sharland GK, Katalinic A, Gembruch U. Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart. 2003;89:913–17. doi: 10.1136/heart.89.8.913. - DOI - PMC - PubMed

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