新生儿心房扑动10例临床分析

Clinical analysis of neonatal atrial flutter in ten neonates

目的总结新生儿心房扑动的临床特征、诊疗经过和转归。方法回顾性分析2016年1月至2023年7月南京医科大学第一附属医院新生儿科收治的心房扑动患儿临床资料、治疗方法和随访结果。结果共纳入心房扑动新生儿10例,男7例,女3例;足月儿5例,早产儿5例;胎龄(37.0±2.2)周,出生体重(3162±605)g。6例患儿在宫内已出现胎心增快,生后心率仍偏快;4例患儿在生后4 d内出现心率增快,均经心电图检查确诊。心电图示心房扑动(2~4)∶1传导,心房率(429±27)次/min,心室率(195±33)次/min,下壁导联锯齿状F波均为负向。首选地高辛、普罗帕酮药物复律,复律成功率为8/10,1例转为宽QRS波心动过速伴血流动力学紊乱,予以电复律转复为窦性心律;1例多次电复律仍反复发作,予地高辛、普萘洛尔药物维持,10个月后转为窦性心律。随访至5月龄~7岁,均未复发。结论新生儿心房扑动多表现为心率增快,依靠心电图诊断,药物复律多数有效,必要时需电复律治疗,总体预后良好。

Objective To analyze the clinical characteristics,diagnosis,treatment,and outcomes of neonatal atrial flutter.Methods This retrospective study analyzed the clinical data,treatment,and follow-up outcomes of neonatal atrial flutter cases admitted to the Department of Neonatology at the First Affiliated Hospital of Nanjing Medical University from January 2016 to July 2023.Results A total of 10 neonates diagnosed with atrial flutter were involved in this study,including 7 males and 3 females,with gestational age(37.0±2.2)weeks,and birth weight(3162±605)g.Five of them were born at full term,and the remaining five were preterms.Six of them exhibited an elevation in fetal heart rate in utero,and their heart rate remained relatively fast after birth,another four experienced an increase in heart rate within 4 d after birth.All of them were diagnosed as atrial flutter based on an electrocardiogram,which showed a 2 to 4 over one ratio of atrioventricular conduction with an atrial rate of(429±27)beats/min,and ventricular rate of(195±33)beats/min.The"sawtooth"F waves in inferior leads were all negative.The first choice for pharmacological cardioversion was digoxin and propafenone,with a success rate of 8 out of 10.One case transitioned to a wide QRS tachycardia with hemodynamic disturbances.An electrical cardioversion was performed to restore sinus rhythm.One case remained atrial flutter after repeated episodes of electrical cardioversion,and switched to sinus rhythm 10 months later by digoxin and propranolol.Ten infants were followed up from five months to seven years old,and no recurrence was reported.Conclusions Neonates with atrial flutter mainly manifest increased heart rate.Its diagnosis depends on the electrocardiogram.For neonatal atrial flutter,drug conversion is an effective measure,and electrical cardioversion can be used if necessary.The prognosis of neonatal atrial flutter is generally good.