Incidental finding of supraventricular tachycardia with progression to atrial flutter after electrical cardioversion in neonates

Abstract

Cardiac arrhythmias in newborns, although rare, are often associated with prematurity and congenital heart defects. Atrial flutter, a tachyarrhythmia with a continuous, elevated atrial rhythm, occurs in about 1% of pediatric cases and usually in previously healthy hearts. Supraventricular tachycardia (SVT), an abnormality in electrical conduction above the ventricles, can cause symptoms such as difficulty feeding and irritability. In neonates, SVT may be asymptomatic for long periods but may lead to sudden hemodynamic decompensation. Treatment includes antiarrhythmic medications, with adenosine being the first line. In refractory cases, such as the one described, amiodarone and synchronized electrical cardioversion may be necessary. The case reported describes a newborn with SVT and persistent Atrial Flutter, treated with adenosine, amiodarone and synchronized electrical cardioversion, resulting in normalization of the heart rhythm. The patient progressed well with oral amiodarone, with no sequelae. The combination of drugs and electrical cardioversion is effective for treating complex neonatal arrhythmias.