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Abstract

Atrial flutter is a supraventricular tachyarrhythmia. It is a rare and life-threatening condition during both the fetus and neonatal periods. In severe instances, atrial flutter can compromise circulation and may result in non-immune hydrops fetalis or even fetal demise. Management typically involves the use of antiarrhythmic drugs, transesophageal overdrive pacing, or synchronized direct current cardioversion. Nonetheless, when identified early and treated appropriately, the overall outlook is positive in the majority of cases.


Tachycardia in neonates is defined as a persistent increase in heart rate above 180 beats/min. The incidence of arrhythmias for neonatal period is about 1%.[1] Atrial flutter is an uncommon type of fetal and neonatal arrhythmia. Atrial flutter occurs in approximately 2.1 out of every 100,000 live births, with structural heart defects present in around 36% of these cases.[2] It constitutes about 32% (nearly one third) of all neonatal cardiac arrhythmias.[3] The mechanism of atrial flutter in the newborns remains unknown. This type of arrhythmia is often caused by re-entry circuits confined to the right atrium.[4] It is most commonly seen in children with congenital heart anomalies such as transposition of the great arteries, complex cyanotic heart disease, atrial septal defects, pulmonary stenosis, and abnormalities of the tricuspid valve. Atrial flutter may also arise following surgical procedures involving the atria, particularly after interventions like atrial switch operations for transposition of the great arteries or repair of Tetralogy of Fallot. Although it is relatively rare, atrial flutter can be life-threatening during the fetal and neonatal periods. The condition carries an estimated perinatal mortality rate of around 9%.[5]


We report a case of a newborn with atrial flutter in the Department of Paediatrics at TRIHMS Hospital, Arunachal Pradesh. The patient’s guardian was duly informed and consent was obtained for publication of case report for medical benefit.


We report a case of a term, large for gestational age neonate who was born via lower segment caesarean section with uneventful antenatal history. His heart rate was persistently between 195-205 beats per minute. An electrocardiogram was performed, which was suggestive of atrial flutter. The atrial flutter was resistant to amiodarone therapy. Synchronised cardioversion was performed and normal sinus rhythm was achieved.

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How to Cite
Nandana A., Ngilyang Sunya, Nani Tago, & Rinchin Dorjee Megeji. (2025). A Neonate’s Flutter - A Rare Dance of the Heart. Journal of Evolution of Medical and Dental Sciences, 14(4), 95–98. https://doi.org/10.14260/jemds.v14i4.779
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