What are the mortality risks of pediatric atrial flutter?

Updated: Feb 04, 2019
  • Author: M Silvana Horenstein, MD; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Answer

Morbidity and mortality in patients with atrial flutter largely depend on the following factors:

  • Age at presentation

  • Cardiac anatomy (normal anatomy vs congenital heart disease)

  • Integrity and anatomy of the myocardial conduction system (normal sinus node vs sinus node dysfunction; atrioventricular (AV) block vs normal AV node, with or without accessory pathways)

  • Ventricular function

  • Prompt recognition of the arrhythmia and initiation of adequate therapy

The fetus with atrial flutter may have significant morbidity and be at risk for mortality. According to one review, hydrops fetalis developed in as many as 40% of fetuses with atrial flutter. The mortality rate in these fetuses was 8%. [11]

Mortality in newborns with atrial flutter is uncommon. Most patients remain in sinus rhythm following their initial conversion, and the need for antiarrhythmic prophylaxis in these patients during infancy is debated.

In patients with postoperative atrial flutter that develops late following repair of congenital heart disease, the outcome depends on the atrial flutter rate, conduction ratio, and presence of ventricular dysfunction. In patients who have undergone the Mustard procedure, Holter recordings incidentally capturing episodes of sudden fatality confirm that rapidly conducted atrial flutter is the dysrhythmia most frequently responsible for these fatalities.

In contrast, patients who have undergone the Fontan procedure rarely die suddenly but frequently present with symptomatic atrial flutter. This may be caused by a relatively slower atrial flutter rate, a higher degree of AV conduction block, or both.

Prolonged episodes of atrial flutter in asymptomatic or mildly symptomatic patients may be associated with development of atrial thrombi and although this is rare in the congenital heart disease population as is the possibility of thromboembolic event.

When women with heart disease and arrhythmias reach childbearing age, arrhythmias can recur during pregnancy. These arrhythmias significantly increase the risk both for the mother and fetus.


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