Elsevier

The Journal of Pediatrics

Volume 132, Issue 2, February 1998, Pages 335-339
The Journal of Pediatrics

Fetal atrial flutter: Diagnosis, clinical features, treatment, and outcome,☆☆,

https://doi.org/10.1016/S0022-3476(98)70455-XGet rights and content

Abstract

Objectives: To assess clinical features, treatment efficacy, and outcome of fetal atrial flutter. Study design: All atrial flutter cases seen in our unit between 1988 and 1995 were reviewed retrospectively and compared with the pooled data of 37 echocardiographically documented and published cases. Results: Atrial flutter was found in 15 of 49 (30.6%) fetuses who had been referred because of clinically relevant tachyarrhythmia. Mean age at detection was 34 ± 4 weeks' gestation. Atrial flutter was incessant in 11 and intermittent in 4, with a mean atrial rate of 442 ± 65 beats/min and a mean ventricular rate of 216 ± 28 beats/min. A predominance of 2:1 atrioventricular conduction was observed. In 5 of 15 cases another form of arrhythmia (supraventricular tachycardia, chaotic atrial rhythm, ventricular extrasystoles) coexisted with atrial flutter. Eleven fetuses were treated with maternal digoxin, and five subsequently converted to sinus rhythm. Four fetuses received no medication; of these four, two showed brief self-limited episodes of atrial flutter and two were delivered after detection of the arrhythmia. Only one fetus (6.7%), who did not respond to drug therapy, was delivered prematurely because of mild congestive heart failure. Seven neonates were in atrial flutter at birth; rhythm control could be easily achieved with sotalol or digoxin (n = 5), flecainide (n = 1), or electroconversion (n = 1) within the first 2 days of life without any relapse. Conclusion: Fetal atrial flutter accounts for approximately one third of all clinically relevant tachyarrhythmia. Although the suppression rate of incessant atrial flutter with digoxin is only 50%, this therapy may be useful for its positive inotropic and negative chronotropic properties. In our experience most fetuses with therapy-resistant atrial flutter and absence of 1:1 atrioventricular conduction do not experience congestive heart failure and do not need to be delivered prematurely. After birth, conversion to sinus rhythm was easily achieved in all neonates. (J Pediatr 1998;132:335-9)

Section snippets

Definitions

Intrauterine atrial flutter was defined as a rapid regular atrial rate of 300 to 600 beats/min and a 1:1 atrioventricular conduction, or a variable degree of AV block, resulting in an identical or slower ventricular heart rate. The highest ventricular rate (peak heart rate) was used as an indicator of the severity of fetal tachycardia. Atrial flutter was considered incessant when observed permanently or when present more than 50% of the time during the echocardiographic examination

Clinical Presentation

Atrial flutter was detected in 10 male and 5 female fetuses at a mean gestational age of 34 ± 4 weeks (Table I).

. Characteristics of the patient with fetal atrial flutter

Case, SexGA at detectionAtrial rate (bpm)Peak HR (bpm)Degree of AV blockPatternSigns of CHFTx in uteroGA at birthTx after birthRecurrence of AFlNeonatal ECGHeart disease
1, M373601802:1SustainedNoD(-)40NoNoNormalNo
2, F354602302-3:1SustainedNoD(+)39DNoNormalNo
3, M343001502:1IntermittentNoD(+)38NoNoNormalNo
4, F383781892:1

Incidence and Clinical Presentation of Fetal Atrial Flutter

After a review of the literature, only 37 echocardiographically documented cases of fetal atrial flutter could be found (Table II).

. Echocardiographically diagnosed fetal atrial flutter (n = 52)

AuthorPatientsMean GAMean atrial rateMaximal heart rateCHFPrenatal conversionPostnatal conversionRelapse of AFl after birthMalformation/ death
Kleinman et al.8(1983)1383601801010No
134nmBradycardia10Stillbirth
Hirata et al.7(1985)134460230110No
Vintzileos et al.9(1985)133416208101CHF, prematurity, death

References (28)

  • L. Shenker

    Fetal cardiac arrhythmias

    Obstet Gynecol Surv

    (1979)
  • KJ Anderson et al.

    Fetal cardiac arrhythmia: antepartum diagnosis of a case of congenital atrial flutter

    Arch Dis Child

    (1981)
  • K Hirata et al.

    Successful treatment of fetal atrial flutter and congestive heart failure

    Arch Dis Child

    (1985)
  • CS Kleinman et al.

    In utero diagnosis and treatment of fetal supraventricular tachycardia

    Semin Perinatol

    (1983)
  • Cited by (109)

    • Arrhythmias in children: Too fast or too slow

      2022, Progress in Pediatric Cardiology
    • Fetal Tachycardia

      2022, Maternal Cardiac Care: A Guide to Managing Pregnant Women with Heart Disease
    • Successful treatment of atrial flutter by repeated intraperitoneal and intra-amniotic injections of amiodarone in a fetus with hydrops

      2016, Taiwanese Journal of Obstetrics and Gynecology
      Citation Excerpt :

      The reported incidence of fetal tachycardia is 0.3 cases per 1000 births [1], whereas fetal atrial flutter (AF) accounts for approximately one-third of fetal tachyarrhythmia [2].

    View all citing articles on Scopus

    From the Fetal Cardiology Unit, Division of Pediatric Cardiology, Sainte-Justine Hospital, University of Montreal School of Medicine, Montreal, Quebec, Canada.

    ☆☆

    Reprint requests: Jean-Claude Fouron, MD, Division of Pediatric Cardiology, Sainte-Justine Hospital, 3175, Ch. Côte Ste-Catherine, Montreal, Quebec, Canada, H3T 1C5.

    0022-3476/98/$5.00 + 0  9/21/83223

    View full text