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

Document Type : Case Report


Department of Pediatrics, School of Medicine, Amirkabir Hospital, Arak University of Medical Sciences, Arak, Iran


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


1. Kundak AA, Dilli D, Karagol B, Karadag N, Zenciroglu A, Okumus N, et al. Non benign neonatal arrhythmias observed in a tertiary neonatal intensive care unit. Indian J Pediatr. 2013; 80(7):555-9.
2. Tunaoğlu FS, Yıldırım A, Akça A. Atriyal flattere neden olan hamak mitral kapak: Üç aylık bebek olgu. Türk Pediatri Arşivi. 2013; 48(3):244-7.
3. Özdemir R, Altug N, Dizdae E, Yurttutan S, Öncel MY, Erdeve Ö, et al. Prematüre bir yenidoğanda kardiyoversiyon ile tedavi edilen atriyal flatter 
olgusu. Türkiye Çocuk Hastalıkları Dergisi. 2013; 7(1):47-9.
4. Southall D, Johnson A, Shinebourne E, Johnston P, Vulliamy D. Frequency and outcome of disorders of cardiac rhythm and conduction in a population of newborn infants. Pediatrics. 1981; 68(1):58-66.
5. Wanamaker B, Cascino T, McLaughlin V, Oral H, Latchamsetty R, Siontis KC. Atrial Arrhythmias in pulmonary hypertension: pathogenesis, prognosis and management. Arrhythm Electrophysiol Rev. 2018; 7(1):43-8.
6. Pike JI, Krishnan A, Kaltman J, Donofrio MT. Fetal and neonatal atrial arrhythmias: an association with maternal diabetes and neonatal macrosomia. Prenat Diagn. 2013; 33(12):1152-7.
7. Gad A, Morelli P, Decristofaro J. Perinatal isolated atrial flutter associated with maternal cocaine and opiate use in a late preterm infant. J Matem Fetal Neonatal Med. 2010; 23(9):1062-5.
8. Wilson N, Forfar JD, Godman MJ. Atrial flutter in the newborn resulting from maternal lithium ingestion. Arch Dis Child. 1983; 58(7):538-9.
9. Texter KM, Kertesz NJ, Friedman RA, Fenrich AL Jr. Atrial flutter in infants. J Am Coll Cardiol. 2006; 48(5):1040-6.
10. Gulletta S, Rovelli R, Fiori R, Bella PD. Multiple external electrical cardioversions for refractory neonatal atrial flutter. Pediatr Cardiol. 2012; 33(2):354-6.
11. Lulic Jurjevic R, Podnar T, Vesel S. Diagnosis, clinical features, management, and post-natal follow-up of fetal tachycardias. Cardiol Young. 2009; 19(5):486-93.
12. Ceresnak SR, Starc TJ, Hordof AJ, Pass RH, Bonney WJ, Liberman L. Elevated impedance during cardioversion in neonates with atrial flutter. Pediatr Cardiol. 2009; 30(4):436-40.
13. Roumiantsev S, Settle MD. Atrial flutter in the neonate: a case study. Neonatal Netw. 2017; 36(5):313-7.
14. Yilmaz-Semerci S, Bornaun H, Kurnaz D, Cebeci B, Babayigit A, Buyukkale G, et al. Neonatal atrial flutter: three cases and review of the literature. Turk J Pediatr. 2018; 60(3):306-9.