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Atrial fibrillation (AF) is an extremely rare arrhythmia in neonates and infants. It’s important to note that the most common arrhythmias in this population are supraventricular tachycardias (SVTs), such as atrial flutter and atrioventricular reentrant tachycardia (AVRT).
Here’s a concise overview of atrial fibrillation in neonates:
Key Points:
✅ Incidence: AF is extremely rare in neonates.
✅ Causes: When it does occur, it is typically associated with underlying structural heart disease, metabolic disturbances, or post-operative states after cardiac surgery (e.g., atrial septal defect repair).
✅ Electrocardiography:
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No distinct P waves
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Irregularly irregular ventricular response
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Rapid, chaotic atrial activity
✅ Clinical Significance: -
Because of the rarity in neonates, if AF is identified, it warrants a thorough evaluation for underlying causes (e.g., structural heart disease, myocarditis, metabolic or endocrine abnormalities).
Causes/Associations in Neonates:
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Post-surgical states (e.g., after cardiac surgery)
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Structural heart disease (e.g., atrial septal defects, anomalous pulmonary venous return)
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Electrolyte imbalances (e.g., hypocalcemia, hypokalemia)
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Hypoxia or sepsis
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Thyrotoxicosis (very rare in neonates)
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Myocarditis or cardiomyopathy
Management:
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Stabilize the patient: Assess hemodynamic status.
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Correct reversible factors: Electrolyte imbalances, hypoxia, sepsis.
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Pharmacologic treatment: Rate control is rarely the priority in neonates due to the low incidence. If necessary, medications like beta-blockers or amiodarone can be considered.
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Cardioversion: If hemodynamically unstable or persistent, synchronized cardioversion may be needed.
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Further workup: Echocardiography to assess for structural heart disease.
Key Takeaway:
👉 True atrial fibrillation in neonates is exceedingly rare. If suspected, careful consideration for structural, metabolic, or surgical causes is essential. In practice, atrial flutter or other SVTs are much more likely and should be excluded first.
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