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(3 162±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.
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