Author + information
- Received January 29, 1985
- Revision received April 29, 1985
- Accepted May 16, 1985
- Published online October 1, 1985.
- Arthur Garson Jr., MD, FACC*,
- Margreet Bink-Boelkens, MD,
- Peter S. Hesslein, MD,
- Allan J. Hordof, MD, FACC,
- John F. Keane, MD,
- William H. Neches, MD, FACC,
- Co-Burn J. Porter, MD, FACC,
- the other investigators of the Pediatric Electrophysiology Society*
- ↵aAddress for reprints: Arthur Garson, Jr., MD, Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin, Houston, Texas 77030.
As children with cardiac disease grow older, atrial flutter becomes more prevalent. A collaborative study was performed in 19 institutions to determine the clinical characteristics of these children and the factors affecting prognosis. There were 380 patients with one or more electrocardiographically documented episodes of atrial flutter that first occurred between ages 1 and 25 years (mean age at onset 10.3). Episodes of flutter continued to occur for a mean of 2.5 years after the onset. Of the 380 patients, 60% had repaired congenital heart disease, 13% palliated congenital heart disease, 8% unoperated congenital heart disease, 8% an otherwise normal heart, 6% cardiomyopathy, 4% rheumatic heart disease and 2% other lesions.
Overall, drugs were effective in eliminating atrial flutter in 58% of patients; specifically, amiodarone and digoxin plus quinidine were effective in 53%, digoxin alone in 44% and propranolol in 21%. Arniodarone was effective in seven (78%) of nine patients. Corrective surgery was performed after the onset of atrial flutter in 66 patients; in 52% the atrial flutter was easier to control or it resolved and in only 4% it was worse. At follow-up (mean 6.5 years), 83% of the patients were alive (49% without atrial flutter and 34% with atrial flutter) and 17% died (10% suddenly, 6% of nonsudden cardiac cause and 1% of noncardiae cause). Cardiac death occurred in 20% of those for whom an effective drug could not be found to eliminate atrial flutter compared with 5% of those who were treated with an effective drug (p < 0.001).
In conclusion: 1) The goal of medical therapy should be to eliminate episodes of atrial flutter because the chance of sudden death is four times higher in patients who continue to have episodes of atrial flutter. 2) If the hemodynamic results can be improved with an operation, it should be performed because possible amelioration of flutter outweighs the risk of worsening flutter by more than 10 to 1.
- Received January 29, 1985.
- Revision received April 29, 1985.
- Accepted May 16, 1985.
- American College of Cardiology Foundation