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European Heart Journal 1992 13(10):1410-1415;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Atrial automatic tachycardia in infancy and childhood

G. VON BERNUTH*,, W. ENGELHARDT*, H. H. KRAMER{dagger}, H. SINGER{ddagger}, P. SCHNEIDER§, H. ULMER||, S. BRODHERR-HEBERLEIN, W. KIENAST**, D. LANG{dagger}{dagger}, A. LINDINGER{ddagger}{ddagger} and K. SCHMIDT§§

*Department of Pediatric Cardiology RWTH Aachen
{dagger}University of Düsseldorf Germany
{ddagger}University of Erlangen Germany
§University of Leipzig Germany
||University of Giessen Germany
¶University of München (DJH) Germany
**University of Erlangen(DJH) Germany
{dagger}{dagger}University of Ulm Germany
{ddagger}{ddagger}University of Homburg Germany
§§University of Heidelberg Germany

Received 15 November 1991; revised 9 April 1992; .

Correspondence Prof. Dr G von Bernuth, Klinik fur Kinderlcardiologie, Medizinische Fakullat der RWTH Aachen. Pauwclsstr. 30, 5100 Aachen. Germany

Abstract

Twenty-one cases (13 male, eight female) of atrial automatic tachycardia (AAT) assessed by standard and Holter-ECG in otherwise healthy infants and children have been documented. A AT was incessant in 12 patients, repetitive in seven, and of undetermined type in the remaining two. The frontal P wave axis suggested an ectopic focus in the high right atrium or right atrial appendage in 13 patients, in the low right atrium in one patient, and in the left atrium in seven patients. Thirteen out of 14 patients with the incessant or undetermined type of AAT were symptomatic, in contrast to only two of seven patients with the repetitive type. All patients were treated with between one and eight (median three) antiarrhythmic drugs. The most effective drug was amiodarone, followed by the class IC antiarrhythmic drugs, propafenone andfiecainide. At present, all patients are alive 4 months to 21 years (median 2·5 years) after diagnosis of AAT. Twelve patients are in sinus rhythm, five of them without any medication. Nine patients still have AAT, which, however, is repetitive or intermittent in all but one. In conclusion, AAT is an unusual, and in its incessant form often severely symptomatic arrhythmia, which is resistant to conventional antiarrhythmic medication. However, amiodarone and class IC antiarrhythmic drugs are frequently effective. Since medical treatment with these drugs is often successful, and AAT may resolve completely, a conservative approach is indicated in many cases.

Key Words: Atrial automatic tachycardia • atrial ectopic tachycardia • children • medical treatment


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