G249(P) Atrial arrhythmias following umbilical catherisation

Case description An infant born at 35 weeks gestation to an insulin dependent diabetic and hypertensive mother was admitted to neonatal unit due to respiratory distress and hypoglycaemia. UVC was inserted as blood sugars were persistently below 2 mmol/L. Soon after the UVC placement baby became increasingly tachycardic with a heart rate greater than 200 per minute with narrow complex tachycardia on the ECG. The UVC was pulled back from its initial high position within the cardiac silhouette and subsequently removed but the tachycardia persisted. There was no response to IV Adenosine and Amiodarone, and a second ECG revealed Atrial Flutter. Serum biochemistry was normal and an Echocardiogram did not reveal anatomical abnormalities. Synchronised shock of 0.5 Joules/kg restored sinus rhythm and the baby remained in sinus rhythm till discharge without requiring any further treatment. Conclusion There are only few reports in literature of atrial flutter following UVC insertion. Mother was diabetic which was an additional risk factor for neonatal arrhythmias.Electrical cardioversion has good effect in restoring sinus rhythm and maintenance antiarrhythmics are usually not needed as risk of recurrence is low.