Intermittent atrial flutter: A cause of recurrent syncope in a 3 year old child - A challenging case

摘要

A 3 year old male child presented to us with 2 months history of frequent episodes of sweating, chest discomfort, and irritability followed by syncope. He underwent ventricular septal defect closure at the age of 6 months. He was on regular follow up and was doing well. After admission, 2D echocardiogram was normal with normal biventricular function. Other systems including central nervous system were normal. Baseline heart rate was 85/min. ECG showed significant ST segment depression of >2 mm in lead II, III and lateral leads (Fig. 1) on each occasion. Child was not on any medication (especially digoxin) and all investigations including electrolytes were within normal range.