Sandra Cerar
Klinični oddelek za neonatologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

Miroslav Elek
Oddelek Službe za kardiologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

Abstract

Cardiac arrhythmias often occur in the neonatal period. They can occur in children with a structurally normal heart as well as in children with congenital heart diseases. The most com-mon pathological tachycardia in the newborn is supraventricular tachycardia with a narrow QRS complex, followed by atrial flutter. The mechanisms for the development of tachyarrhythmias can be enhanced conduction with the presence of re-entry circuits or enhanced automaticity with triggered foci. Risk factors for arrhythmias include congenital cardiac malformations, prematurity, electrolyte disorders, exposure to proarrhytmogenic ? proarrhythmic drugs, infections and fever, although they are present only in the minority of neo-nates. The clinical presentation may be subtle and non-specific; it may include refusal to feed, lethargy, irritability, tachypnoea, pallor, cyanosis, sweating and grunting. Some arrhythmias can lead to severe circulatory failure. Arrhythmias are relatively common in the paediatric cardiac intensive care unit in patients within 24 hours after heart surgery. and may cause significant hemodynamic instability and compromise. The acute management includes the use of vagal manoeuvres, intravenous adenosine, antiarrhythmic drugs and cardioversion. This review aims to provide a framework for the diagnosis and management of neonatal tachycardias. Two case reports of neonatal tachycardia are described.

Key words: supraventricular tachycardia, atrioventricular re-entry tachycardia, atrial flutter, arrhythmia, neonate, pathophysiology, management