Atrial Flutter in a Newborn: A Case Report

Document Type : Case Report


1 Neonatal Health Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Neonatal Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Immunology and Allergy ,faculty of medicine, Mashhad University of medical sciences, Mashhad, Iran

4 Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran

5 Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran


Background: Arrhythmia detection in neonates is substantially different from that in older children. The natural history of arrhythmias in the neonatal age group also differs markedly from other ages. Neonatal Cardiac Arrhythmias are found in 1% to 5% of newborns during the first 10 days of life. Most are premature supraventricular tachycardia (SVT) beats that will disappear over the first month of life. The most common symptomatic arrhythmia in the neonatal period is SVT, which has an incidence of 1/25,000. Idiopathic neonatal atrial flutter (AFL) is a rare rhythm disorder usually occurring in the first days of life and characterized by sustained tachycardia in newborns and infants with an atrial rate of often at around 340-580 beats/min. AFL may manifest as asymptomatic tachycardia, congestive heart failure, or hydrops and may be life-threatening and fatal.
Case report: We reported a 38-weak-female baby presented with tachycardia during the first physical examination. The patient underwent adenosine therapy twice, and when the electrocardiogram demonstrated atrial flutter, the next choice was cardioversion. After using cardioversion with a dose of 2 J, the rhythm converted to the normal sinus and the following clinical and laboratory tests showed no abnormality. With early prenatal diagnosis and prompt therapeutic approaches, most of the patients showed good prognosis and there was no need for chronic therapy.
Conclusion: Since AFL may result in severe heart failure and even death, it should be noted that careful clinical examination and on-time diagnosis of cardiac arrhythmia are of significant importance.


  1. Saeidi R, Izanloo A, Izanlou S. A Study of the Relationship between Job Satisfaction and Burnout among Neonatal Intensive Care Unit Staff. Iranian Journal of Neonatology. 2020;11(1).
  2. 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.
  3. Umeh M, Klutse T, Richards J, Kulkarni A. Electrical direct current cardioversion for the treatment of atrial flutter in extremely premature neonate. Arch Dis Child Fetal Neonatal Ed. 2017; 102(5):466-7.
  4. Prasad D, Steinberg J, Snyder C. Cost-effectiveness of digoxin, pacing, and direct current cardioversion for conversion of atrial flutter in neonates. Cardiol Young. 2018; 28(5):725-9.
  5. Low S, Kiper C, Armstrong A, Cua CL. Echocardiographic diagnosis of atrial flutter in a neonate. Echocardiography. 2018; 35(9):1439-41.
  6. Sobaih B. Fetal tachycardia as neonatal atrial flutter-A case report. ABSRACT. Apert Syndrome Presented with CDH; 2017.
  7. James H, Moller JH DF, Anderson RS. Atrial flutter in infancy. J Pediatr. 1999; 75:643-51.
  8. Wren C. Cardiac arrhythmias in the fetus and newborn. Semin Fetal Neonatal Med.2006; 11(3):182-90.
  9. 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.
  10. Rhodes LA, Walsh EP, Saul JP. Conversion of atrial flutter in pediatric patients by transesophageal atrial pacing: a safe, effective, minimally invasive procedure. Am Heart J. 1995; 130(2):323-7.