A Case Report of Neonatal Atrial Flutter with Poor Feeding and Tachypnea

Arrhythmias in neonates are not common and usually affect newborns with a normal heart or those that suffer from structural heart disease. A malignant type of arrhythmias is supraventricular tachycardia. Meanwhile, one uncommon type of supraventricular arrhythmias is atrial flutter (AFL), which is founded upon reentry mechanisms in the atrium. The AFL may result in heart failure or even death, but the majority of its cases have revealed favorable prognosis in the event of early prenatal diagnosis and immediate treatment.

A four-day term male newborn with a birth weight of 4,560 g born to a 43-year-old multiparous mother was delivered through cesarean section. The patient’s admission to the hospital was on account of her poor feeding and tachypnea. The results of physical checkup exhibited tachycardia with 210 beats/min, and electrocardiogram (ECG) indicated a narrow QRS complex tachycardia with P-waves in the leads II and III that showed AFL. The adenosine injection revealed atrioventricular conduction 2.1. Therefore, oral propranolol therapy with a dosage of 3 mg/kg/day was prescribed for the patient. Given the recurrence of AFL, cardioversion was conducted with 0.25 joule/kg until the rhythm was restored to normal. Later, the normal sinus rhythm was observed on ECG. Fifteen days after birth, the patient was discharged with a perfect general state. The results of a 6-month follow-up did not show any AFL.

Despite its rare occurrence, AFL must be considered in the differential diagnosis of newborns with poor feeding with tachypnea and tachycardia.