Instant Electrocardiographic Diagnosis of Neonatal Atrial Flutter Using Inter-QRS Segment Pattern Recognition

Neonatal atrial flutter (NAF) is a rare type of macroreentrant supraventricular tachycardia. In this report, we describe a case of atrial flutter in an 8-day-old neonate with a total anomalous pulmonary venous connection. Additionally, we introduce a diagnostic triad for ECG identification of this condition. This triad is composed of 3 components: similar shapes of inter-QRS segments (SIS) in leads II, III, and aVF, different shapes of inter-QRS segments (DIS) in lead I, and the occurrence of 1 or multiple stretched M or inverted V shapes in the inter-QRS (IQS) segment in leads II, III, and aVF. We assessed the effectiveness of this triad through a validation cohort, using previously reported cases of NAF from the literature. The sensitivity rates for detecting SIS and DIS patterns and the singular or multiple reversed W or V signs were 100%, 81%, and 100%, respectively. Furthermore, all 3 components of the triad were found in 81% of neonates diagnosed with atrial flutter. The emergence of this triad can be attributed to the elimination of the isoelectric segment in ECG, caused by the extended duration of flutter waves originating from macroreentry within the atrium and the rapid atrial rate characteristic of atrial flutter.