Pediatric Atrial Ectopic Tachycardia Clinical Presentation

  • Author: Shubhayan Sanatani, MD; Chief Editor: Stuart Berger, MD   more...
 
Updated: Mar 29, 2011
 

History

Although atrial ectopic tachycardia (AET) is occasionally encountered in patients following surgery for congenital heart disease, most patients have structurally normal hearts and are symptomatic. Palpitations, chest pain, lightheadedness, presyncope, and dyspnea are the most common symptoms.

Asymptomatic or preverbal patients may be noted to be tachycardic or dyspneic on routine evaluation. Difficulty feeding or diaphoresis may accompany the tachycardia in infants.

Exercise intolerance and heart failure are late manifestations of secondary cardiac dysfunction.

The history must be sufficiently broad to rule out causes of persistently elevated heart rates, such as hyperthyroidism, anemia, or catecholamine-producing malignancy. The family history is rarely positive for atrial ectopic tachycardia.

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Physical Examination

The heart rate is inappropriately elevated for the degree of activity. If second-degree atrioventricular (AV) block is present, the heart rate may be irregular. The patient may be tachypneic. In advanced cardiomyopathy, pulses and perfusion are poor, and evidence of cardiac enlargement is present. Hepatic and pulmonary congestion may be present.

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Contributor Information and Disclosures
Author

Shubhayan Sanatani, MD  Associate Professor, Department of Pediatrics, University of British Columbia Faculty of Medicine; Consulting Staff, Division of Pediatric Cardiology, British Columbia Children's Hospital, Canada

Shubhayan Sanatani, MD is a member of the following medical societies: British Columbia Medical Association, Canadian Cardiovascular Society, Canadian Heart Rhythm Society, Canadian Heart Rhythm Society, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Murray Hamilton, MD, MSc, FRCPC  Section Head, Electrophysiology, Director, High-Risk Hereditary Heart Conditions Clinic, Labatt Family Heart Centre; Professor, Department of Pediatrics, Associate Scientist, Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, University of Toronto Faculty of Medicine, Canada

Robert Murray Hamilton, MD, MSc, FRCPC is a member of the following medical societies: American Heart Association, Canadian Cardiovascular Society, Canadian Medical Association, Canadian Medical Protective Association, Cardiac Electrophysiology Society, Heart Rhythm Society, Ontario Medical Association, Pediatric Electrophysiology Society, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Charles I Berul, MD  Professor of Pediatrics and Integrative Systems Biology, George Washington University School of Medicine; Chief, Division of Cardiology, Children's National Medical Center

Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society, and Society for Pediatric Research

Disclosure: Johnson & Johnson Consulting fee Consulting

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Hugh D Allen, MD  Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

References

  1. Dagres N, Gutersohn A, Wieneke H, Sack S, Erbel R. A new hereditary form of ectopic atrial tachycardia with autosomal dominant inheritance. Int J Cardiol. Feb 2004;93(2-3):311-3. [Medline].

  2. Bauersfeld U, Gow RM, Hamilton RM, Izukawa T. Treatment of atrial ectopic tachycardia in infants < 6 months old. Am Heart J. Jun 1995;129(6):1145-8. [Medline].

  3. Salerno JC, Kertesz NJ, Friedman RA, Fenrich AL Jr. Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children or =3 years of age. J Am Coll Cardiol. Feb 4 2004;43(3):438-44. [Medline].

  4. Gelb BD, Garson A Jr. Noninvasive discrimination of right atrial ectopic tachycardia from sinus tachycardia in "dilated cardiomyopathy". Am Heart J. 1990;120:886-91. [Medline].

  5. Kistler PM, Roberts-Thomson KC, Haqqani HM, Fynn SP, Singarayar S, Vohra JK. P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol. Sep 5 2006;48(5):1010-7. [Medline].

  6. Higa S, Tai CT, Lin YJ, et al. Focal atrial tachycardia: new insight from noncontact mapping and catheter ablation. Circulation. Jan 6 2004;109(1):84-91. [Medline]. [Full Text].

  7. Liew R, Catanchin A, Behr ER, Ward D. Use of non-contact mapping in the treatment of right atrial tachycardias in patients with and without congenital heart disease. Europace. Aug 2008;10(8):972-81. [Medline].

  8. Cummings RM, Mahle WT, Strieper MJ, Campbell RM, Costello L, Balfour V. Outcomes following electroanatomic mapping and ablation for the treatment of ectopic atrial tachycardia in the pediatric population. Pediatr Cardiol. Mar 2008;29(2):393-7. [Medline].

  9. Haas NA, Fox S, Skinner JR. Successful use of an intravenous infusion of flecainide and amiodarone for a refractory combination of postoperative junctional and ectopic tachycardias. Cardiol Young. Aug 2005;15(4):427-30. [Medline].

 
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