Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

The Complexity of Pediatric Multifocal Atrial Tachycardia and Its Prognostic Factors

  • Baek, Seung Min (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Chung, Hyun (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Song, Mi Kyoung (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Bae, Eun Jung (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Kim, Gi Beom (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Noh, Chung Il (Department of Pediatrics, Seoul National University Children's Hospital)
  • Received : 2017.08.10
  • Accepted : 2017.10.26
  • Published : 2018.02.28
⟨ Previous Next ⟩

Abstract

Background and Objectives: Multifocal atrial tachycardia (MAT), in general, has a favorable outcome. However, there are insufficient data regarding MAT in a pediatric population. This study sought to determine the clinical course of MAT and identify potential prognostic factors. Methods: The medical records of MAT patients from 1997-2015 were reviewed. The arrhythmia control rate and factors for unfavorable outcomes were assessed and compared to those in the literature. Results: Of the 33 included patients (19 boys and 14 girls), 27 were infants less than 1 year of age. The median age at diagnosis was 1.7 months (range, 0 day to 14 years). Fourteen (42%) patients had structural heart disease. Eight (24%) patients had lung disease and 6 (18%) had a syndromic diagnosis belonging to RASopathy. Two patients developed polymorphic ventricular tachycardia, in whom genetic analysis confirmed the presence of the RyR2 mutation several years later. MAT was controlled in 26 patients (84%) within 3.9 months (median; range, 16 days-18.4 years) using an average of 2.4 medications. There were 3 cases of cardiopulmonary mortality. The arrhythmia control rate was higher in the infant group (85%) than in the non-infant group (67%), although this trend was not statistically significant. There was a significantly lower rate of unfavorable outcomes in the idiopathic infant group (n=11) than in the other groups (p=0.008). Considering the findings of previous studies, the mortality rate was significantly higher in patients with structural heart disease than in patients without (21% vs. 5%, p=0.01). Conclusion: MAT usually affects infants and has a favorable prognosis, particularly in the idiopathic infant group. However, in the presence of other comorbidities, MAT may have a variable clinical course.

Keywords

References

  1. Bradley DJ, Fischbach PS, Law IH, Serwer GA, Dick M 2nd. The clinical course of multifocal atrial tachycardia in infants and children. J Am Coll Cardiol 2001;38:401-8. https://doi.org/10.1016/S0735-1097(01)01390-0
  2. Lazaros G, Chrysohoou C, Oikonomou E, et al. The natural history of multifocal atrial rhythms in elderly outpatients: insights from the “Ikaria study”. Ann Noninvasive Electrocardiol 2014;19:483-9. https://doi.org/10.1111/anec.12165
  3. Kastor JA. Multifocal atrial tachycardia. N Engl J Med 1990;322:1713-7. https://doi.org/10.1056/NEJM199006143222405
  4. Fish FA, Mehta AV, Johns JA. Characteristics and management of chaotic atrial tachycardia of infancy. Am J Cardiol 1996;78:1052-5. https://doi.org/10.1016/S0002-9149(96)00536-X
  5. Liberthson RR, Colan SD. Multifocal or chaotic atrial rhythm: report of nine infants, delineation of clinical course and management, and review of the literature. Pediatr Cardiol 1982;2:179-84. https://doi.org/10.1007/BF02332108
  6. Yeager SB, Hougen TJ, Levy AM. Sudden death in infants with chaotic atrial rhythm. Am J Dis Child 1984;138:689-92.
  7. Dodo H, Gow RM, Hamilton RM, Freedom RM. Chaotic atrial rhythm in children. Am Heart J 1995;129:990-5. https://doi.org/10.1016/0002-8703(95)90121-3
  8. Salim MA, Case CL, Gillette PC. Chaotic atrial tachycardia in children. Am Heart J 1995;129:831-3. https://doi.org/10.1016/0002-8703(95)90339-9
  9. Farooki ZQ, Green EW. Multifocal atrial tachycardia in two neonates. Br Heart J 1977;39:872-4. https://doi.org/10.1136/hrt.39.8.872
  10. Beitzke A. Multifocal (chaotic) atrial tachycardia in infancy. Helv Paediatr Acta 1979;34:319-27.
  11. Chantepie A, Ramponi N, Vaillant MC, Laugier J, Raynaud P, Fauchier JP. Polymorphic atrial tachycardia and Wolff-Parkinson-White syndrome in a newborn infant. Arch Mal Coeur Vaiss 1986;79:1371-5.
  12. Bisset GS 3rd, Seigel SF, Gaum WE, Kaplan S. Chaotic atrial tachycardia in childhood. Am Heart J 1981;101:268-72. https://doi.org/10.1016/0002-8703(81)90189-7
  13. Lipson MJ, Naimi S. Multifocal atrial tachycardia (chaotic atrial tachycardia). Clinical associations and significance. Circulation 1970;42:397-407. https://doi.org/10.1161/01.CIR.42.3.397
  14. Tutar E, Çiftçi Ö, Fitoz S, et al. Lipomatous hypertrophy of the interatrial septum in a child with atrial tachycardia. Pediatr Int 2016;58:523-5. https://doi.org/10.1111/ped.12917
  15. Hsieh MY, Lee PC, Hwang B, Meng CC. Multifocal atrial tachycardia in 2 children. J Chin Med Assoc 2006;69:439-43. https://doi.org/10.1016/S1726-4901(09)70288-6
  16. Di Pino A, Caruso E, Costanzo L, Guccione P. A novel RyR2 mutation in a 2-year-old baby presenting with atrial fibrillation, atrial flutter, and atrial ectopic tachycardia. Heart Rhythm 2014;11:1480-3. https://doi.org/10.1016/j.hrthm.2014.04.037
  17. Broendberg AK, Nielsen JC, Bjerre J, et al. Nationwide experience of catecholaminergic polymorphic ventricular tachycardia caused by RyR2 mutations. Heart 2017;103:901-9. https://doi.org/10.1136/heartjnl-2016-310509
  18. Lin AE, Alexander ME, Colan SD, et al. Clinical, pathological, and molecular analyses of cardiovascular abnormalities in Costello syndrome: a Ras/MAPK pathway syndrome. Am J Med Genet A 2011;155A:486-507.
  19. Prada CE, Zarate YA, Hagenbuch S, Lovell A, Schorry EK, Hopkin RJ. Lethal presentation of neurofibromatosis and Noonan syndrome. Am J Med Genet A 2011;155A:1360-6.
  20. Finsterer J, Stollberger C, Stubenberger E, Tschakoschian S. Lymphangiopathy in neurofibromatosis 1 manifesting with chylothorax, pericardial effusion, and leg edema. Int J Gen Med 2013;6:743-6.
  21. Pickoff AS, Singh S, Flinn CJ, McCormack J, Stolfi A, Gelband H. Atrial vulnerability in the immature canine heart. Am J Cardiol 1985;55:1402-6. https://doi.org/10.1016/0002-9149(85)90513-2
  22. Zeevi B, Berant M, Sclarovsky S, Blieden LC. Treatment of multifocal atrial tachycardia with amiodarone in a child with congenital heart disease. Am J Cardiol 1986;57:344-5. https://doi.org/10.1016/0002-9149(86)90920-3
  23. Houyel L, Fournier A, Davignon A. Successful treatment of chaotic atrial tachycardia with oral flecainide. Int J Cardiol 1990;27:27-9. https://doi.org/10.1016/0167-5273(90)90187-A
  24. Cetta F, Bell TJ, Ros SP. Emergency department evaluation of an infant with chaotic atrial tachycardia. Pediatr Emerg Care 1997;13:120-2. https://doi.org/10.1097/00006565-199704000-00010
  25. Bouziri A, Khaldi A, Hamdi A, et al. Multifocal atrial tachycardia: an unusual cause of cardiogenic shock in a newborn. Tunis Med 2011;89:59-61.
  26. Pregowska K, Jurkiewicz E, Miszczak-Knecht M, Turska-Kmiec A, Bieganowska K. Persistent multifocal atrial tachycardia in infant with encephalocraniocutaneous lipomatosis: a case report. Eur J Pediatr 2014;173:1577-80. https://doi.org/10.1007/s00431-013-2103-7

Cited by

  1. Ivabradine as a stabilising anti-arrhythmic agent for multifocal atrial tachycardia vol.30, pp.6, 2018, https://doi.org/10.1017/s1047951120001195