The Complexity of Pediatric Multifocal Atrial Tachycardia and Its Prognostic Factors
- Author:
Seung Min BAEK
1
;
Hyun CHUNG
;
Mi Kyoung SONG
;
Eun Jung BAE
;
Gi Beom KIM
;
Chung Il NOH
Author Information
- Publication Type:Original Article
- Keywords: Supraventricular tachycardias; Atrial fibrillation; Atrial flutter
- MeSH: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Comorbidity; Diagnosis; Heart Diseases; Humans; Infant; Lung Diseases; Medical Records; Mortality; Prognosis; Ryanodine Receptor Calcium Release Channel; Tachycardia; Tachycardia, Supraventricular; Tachycardia, Ventricular
- From:Korean Circulation Journal 2018;48(2):148-158
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND OBJECTIVES: Multifocal atrial tachycardia (MAT), in general, has a favorable outcome. However, there are insufficient data regarding MAT in a pediatric population. This study sought to determine the clinical course of MAT and identify potential prognostic factors. METHODS: The medical records of MAT patients from 1997–2015 were reviewed. The arrhythmia control rate and factors for unfavorable outcomes were assessed and compared to those in the literature. RESULTS: Of the 33 included patients (19 boys and 14 girls), 27 were infants less than 1 year of age. The median age at diagnosis was 1.7 months (range, 0 day to 14 years). Fourteen (42%) patients had structural heart disease. Eight (24%) patients had lung disease and 6 (18%) had a syndromic diagnosis belonging to RASopathy. Two patients developed polymorphic ventricular tachycardia, in whom genetic analysis confirmed the presence of the RyR2 mutation several years later. MAT was controlled in 26 patients (84%) within 3.9 months (median; range, 16 days–18.4 years) using an average of 2.4 medications. There were 3 cases of cardiopulmonary mortality. The arrhythmia control rate was higher in the infant group (85%) than in the non-infant group (67%), although this trend was not statistically significant. There was a significantly lower rate of unfavorable outcomes in the idiopathic infant group (n=11) than in the other groups (p=0.008). Considering the findings of previous studies, the mortality rate was significantly higher in patients with structural heart disease than in patients without (21% vs. 5%, p=0.01). CONCLUSIONS: MAT usually affects infants and has a favorable prognosis, particularly in the idiopathic infant group. However, in the presence of other comorbidities, MAT may have a variable clinical course.
