Atrial Flutter in Infants

ObjectivesWe sought to characterize the clinical nature of atrial flutter (AFL) in a large cohort of infants.BackgroundThere are no large studies describing the natural history of AFL in infants. Previous studies vary in the therapy used and expected prognosis.MethodsWe reviewed the records of all children younger than 1 year of age who were diagnosed with AFL at our hospital during the past 25 years, excluding those with previous cardiac surgery.ResultsWe identified 50 infants with AFL. Most, 36 (72%), presented within the first 48 h of life. Congestive heart failure was evident in 10 infants, with 6 presenting at 1 day of age, and 4 presenting beyond 1 month of age. The remainder were asymptomatic. A large atrial septal defect was the only structural heart disease. Spontaneous conversion to sinus rhythm occurred in 13 (26%) infants. Sinus rhythm was restored in 20 of 23 (87%) attempts at direct current cardioversion and 7 of 22 (32%) attempts at transesophegeal pacing; 7 required antiarrhythmic therapy. An additional arrhythmia, all supraventricular, appeared in 11 (22%) infants. The recurrence of AFL developed in 6 infants; 5 of 6 of these incidents occurred within 24 h of the first episode. All patients with recurrence had an additional arrhythmia.ConclusionsInfants with AFL usually present within the first 2 days of life. No association was found with structural heart disease. Direct current cardioversion appears to be most effective at establishing sinus rhythm. Chronic AFL has the potential to cause cardiovascular compromise. Atrial flutter in the absence of other arrhythmias has a low risk of recurrence. Once in sinus rhythm, infants with AFL have an excellent prognosis and may not require chronic antiarrhythmic therapy

Long QT and Hearing Loss in High-Risk Infants Prospective Study Registry.

The objective of this study is to determine the prevalence of an abnormal electrocardiogram showing a prolonged QTc greater than 450 ms in infants with unilateral or bilateral sensorineural hearing loss. We conducted a prospective study of healthy term infants (≥37 weeks gestational age) who failed their newborn auditory brainstem response hearing screen, were seen by an audiologist and diagnosed as having sensorineural hearing loss during follow-up to 1 year of age. In infants with a diagnosis of hearing loss, we collected a detailed family history and performed an ECG between 2 and 6 months of age. We obtained follow-up for 1 year by calling the parent requesting the hearing and cardiac status of their child. Two of the 40 infants with sensorineural hearing loss (5%) had a QTc greater than 450 ms. Both had mild bilateral hearing loss and genetic testing did not identify a known mutation for long QT syndrome. The remaining 38 infants had QTc intervals of ≤ 450 ms. One patient diagnosed with bilateral severe sensorineural hearing loss had a normal ECG (QTc = 417 ms). Several months after the ECG was performed, the infant\u27s mother contacted the study cardiologist after she learned that the infant\u27s maternal grandmother was diagnosed with a cardiomyopathy and arrhythmias. Genetic testing was recommended even though the child was asymptomatic and was positive for a pathogenic mutation in the KCNQ1 gene. We speculate that molecular genetic testing in infants with hearing loss may become the standard of care rather than targeted electrocardiograms.Clinical Trial Registration NCT02082431 https://www.clinicaltrials.gov/ct2/show/NCT02692521?cond=NCT02692521&rank=1

A decade of the Super Dual Auroral Radar Network (SuperDARN): scientific achievements, new techniques and future directions

The Super Dual Auroral Radar Network (SuperDARN) has been operating as an international co-operative organisation for over 10 years. The network has now grown so that the fields of view of its 18 radars cover the majority of the northern and southern hemisphere polar ionospheres. SuperDARN has been successful in addressing a wide range of scientific questions concerning processes in the magnetosphere, ionosphere, thermosphere, and mesosphere, as well as general plasma physics questions. We commence this paper with a historical introduction to SuperDARN. Following this, we review the science performed by SuperDARN over the last 10 years covering the areas of ionospheric convection, field-aligned currents, magnetic reconnection, substorms, MHD waves, the neutral atmosphere, and E-region ionospheric irregularities. In addition, we provides an up-to-date description of the current network, as well as the analysis techniques available for use with the data from the radars. We conclude the paper with a discussion of the future of SuperDARN, its expansion, and new science opportunities