Atrial flutter is uncommon in neonates without congenital heart disease or cardiac surgery. It forms about 3% of cardiac arrhythmias in the newborn.¹ Although idiopathic atrial flutter can occur in the fetus,^2,3 accounting for 30% of fetal arrhythmias in one series,⁴ spontaneous conversion often occurs during birth. I share our experience of two preterm babies who had atrial flutter associated with maternal opiate abuse. There are no previous case reports on this association.

The first case was of a 27 week gestation baby born to …