{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:28:53Z","timestamp":1785767333764,"version":"3.56.0"},"reference-count":60,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:00:00Z","timestamp":1683244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: In neonates, cardiac arrhythmias are rare. Electric countershock therapy is an effective alternative to drug therapy for neonatal arrhythmias. There are no randomized controlled studies investigating electric countershock therapy in neonates. Objective: To identify all studies and publications describing electric countershock therapy (including defibrillation, cardioversion, and pacing) in newborn infants within 28 days after birth, and to provide a comprehensive review of this treatment modality and associated outcomes. Methods: For this systematic review we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). All articles reporting electric countershock therapy in newborn infants within 28 days after birth were included. Results: In terms of figures, 113 neonates who received electric countershock due to arrhythmias were reported. Atrial flutter (76.1%) was the most common arrhythmia, followed by supraventricular tachycardia (13.3%). Others were ventricular tachycardia (9.7%) and torsade de pointes (0.9%). The main type of electric countershock therapy was synchronized cardioversion (79.6%). Transesophageal pacing was used in twenty neonates (17.7%), and defibrillation was used in five neonates (4.4%). Conclusion: Electric countershock therapy is an effective treatment option in the neonatal period. In atrial flutter especially, excellent outcomes are reported with direct synchronized electric cardioversion.<\/jats:p>","DOI":"10.3390\/children10050838","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T03:34:53Z","timestamp":1683516893000},"page":"838","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cardiac Arrhythmias Requiring Electric Countershock during the Neonatal Period\u2014A Systematic Review"],"prefix":"10.3390","volume":"10","author":[{"given":"Nathalie","family":"Oeffl","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3429-7597","authenticated-orcid":false,"given":"Marlies","family":"Krainer","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Kurath-Koller","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-7859","authenticated-orcid":false,"given":"Martin","family":"Koestenberger","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5499-3712","authenticated-orcid":false,"given":"Bernhard","family":"Schwaberger","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berndt","family":"Urlesberger","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3932-665X","authenticated-orcid":false,"given":"Lukas","family":"Mileder","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s00246-008-9355-4","article-title":"Arrhythmia in the neonatal intensive care unit","volume":"30","author":"Badrawi","year":"2009","journal-title":"Pediatr. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"F177","DOI":"10.1136\/adc.2009.169102","article-title":"Changes in heart rate in the first minutes after birth","volume":"95","author":"Dawson","year":"2010","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.clp.2015.11.007","article-title":"Fetal and Neonatal Arrhythmias","volume":"43","author":"Jaeggi","year":"2016","journal-title":"Clin. Perinatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1161\/CIRCULATIONAHA.111.026120","article-title":"Comparison of Transplacental Treatment of Fetal Supraventricular Tachyarrhythmias with Digoxin, Flecainide, and Sotalol","volume":"124","author":"Jaeggi","year":"2011","journal-title":"Circulation"},{"key":"ref_5","first-page":"CD009803","article-title":"Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest","volume":"2014","author":"Huang","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1017\/S104795111800029X","article-title":"Cost-effectiveness of digoxin, pacing, and direct current cardioversion for conversion of atrial flutter in neonates","volume":"28","author":"Prasad","year":"2018","journal-title":"Cardiol. Young"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/S0735-1097(99)00589-6","article-title":"Atrial Flutter in the Perinatal Age Group: Diagnosis, Management and Outcome","volume":"35","author":"Lisowski","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/j.jacc.2006.04.091","article-title":"Atrial Flutter in Infants","volume":"48","author":"Texter","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1542\/peds.75.4.725","article-title":"Atrial flutter in infancy: Diagnosis, clinical features, and treatment","volume":"75","author":"Dunnigan","year":"1985","journal-title":"Pediatrics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"201","DOI":"10.5144\/0256-4947.51775","article-title":"Electrical cardioversion","volume":"29","author":"Saudi","year":"2009","journal-title":"Ann. Saudi Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1161\/CIRCEP.113.000444","article-title":"Infant ventricular fibrillation after ST-segment changes and QRS widening: A new cause of sudden infant death?","volume":"6","author":"Miyake","year":"2013","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e1708","DOI":"10.1097\/PEC.0000000000001074","article-title":"Inappropriate Shocks and Power Delivery Using Adult Automatic External Defibrillator Pads in a Pediatric Patient","volume":"37","author":"Katz","year":"2021","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"F466","DOI":"10.1136\/archdischild-2016-312594","article-title":"Electrical direct current cardioversion for the treatment of atrial flutter in extremely premature neonate","volume":"102","author":"Umeh","year":"2017","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1007\/s00246-021-02549-6","article-title":"Association of Fetal Atrial Flutter with Neonatal Atrioventricular Re-entry Tachycardia Involving Accessory Pathway: A Link to be Remembered","volume":"42","author":"Lewis","year":"2021","journal-title":"Pediatr. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s00246-011-0131-5","article-title":"Multiple external electrical cardioversions for refractory neonatal atrial flutter","volume":"33","author":"Gulletta","year":"2012","journal-title":"Pediatr. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.resuscitation.2005.07.008","article-title":"Problems with the use of self-adhesive electrode pads in neonates","volume":"68","author":"Cornwell","year":"2006","journal-title":"Resuscitation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1046\/j.1460-9592.2002.00865.x","article-title":"The use of methohexital during neonatal cardioversion","volume":"12","author":"Allegaert","year":"2002","journal-title":"Paediatr. Anaesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/BF01708588","article-title":"Rare procedures during delivery room resuscitation\u2014Cardioversion of ventricular tachycardia in an asphyctic neonate","volume":"18","author":"Heinonen","year":"1992","journal-title":"Intensive Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s12098-013-1224-3","article-title":"Successful treatment of atrial flutter with propafenone and synchronized cardioversion in a newborn","volume":"81","author":"Konak","year":"2014","journal-title":"Indian J. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1007\/s12098-015-1766-7","article-title":"Term Infant with Fetal Tachyarrhythmia, Hydrops, and Persistent Pulmonary Hypertension","volume":"82","author":"Cummings","year":"2015","journal-title":"Indian J. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1007\/s00246-011-0037-2","article-title":"Successful treatment of a newborn with genetically confirmed long QT syndrome 3 and repetitive Torsades de Pointes tachycardia","volume":"32","author":"Paech","year":"2011","journal-title":"Pediatr. Cardiol."},{"key":"ref_22","first-page":"262","article-title":"Sawtooth Waves-Atrial Flutter in a Premature Infant","volume":"114","author":"Poryo","year":"2017","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1055\/a-0651-9800","article-title":"Erfolgreiche Kardioversion bei neonatalem Vorhofflattern","volume":"222","author":"Apostolidou","year":"2018","journal-title":"Z. Geburtshilfe Neonatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/BF00441751","article-title":"Severe hydrops fetalis due to congenital supraventricular tachycardia","volume":"144","author":"Rein","year":"1986","journal-title":"Eur. J. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1055\/s-2005-870898","article-title":"Atrial flutter following placement of an umbilical venous catheter","volume":"22","author":"Sinha","year":"2005","journal-title":"Am. J. Perinatol."},{"key":"ref_26","first-page":"39S","article-title":"Fetal atrial flutter and X-linked dominant vitamin D-resistant rickets","volume":"65","author":"Vintzileos","year":"1985","journal-title":"Obs. Gynecol."},{"key":"ref_27","first-page":"726","article-title":"Direct Current Cardioversion in a Case of Congential Atrial Flutter","volume":"15","author":"Chojnacki","year":"1965","journal-title":"Am. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1007\/s00246-003-0226-8","article-title":"Neonatal Intractable Atrial Flutter Successfully Treated with Intravenous Flecainide","volume":"25","author":"Suzumura","year":"2004","journal-title":"Pediatr. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"bcr2015211948","DOI":"10.1136\/bcr-2015-211948","article-title":"Resolution of tachyarrhythmia-related fetal hydrops after corticosteroid administration for fetal lung maturation","volume":"2015","author":"Takei","year":"2015","journal-title":"BMJ Case Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1177\/000992287801700708","article-title":"Neonatal paroxysmal supraventricular tachycardia. The importance of recognition by fetal ECG and of treatment with DC cardioversion","volume":"17","author":"Usnr","year":"1978","journal-title":"Clin. Pediatr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"W\u00f3jtowicz-Marzec, M., Wysoki\u0144ska, B., and Respondek-Liberska, M. (2020). Successful treatment of neonatal atrial flutter by synchronized cardioversion: Case report and literature review. BMC Pediatr., 20.","DOI":"10.1186\/s12887-020-02259-7"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"306","DOI":"10.24953\/turkjped.2018.03.011","article-title":"Neonatal atrial flutter: Three cases and review of the literature","volume":"60","author":"Bornaun","year":"2018","journal-title":"Turk. J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Mileder, L.P., Morris, N.M., Kurath-Koller, S., Pansy, J., Pichler, G., Pocivalnik, M., Schwaberger, B., Burmas, A., and Urlesberger, B. (2021). Successful postnatal cardiopulmonary resuscitation due to defibrillation. Children, 8.","DOI":"10.3390\/children8050421"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/S0002-8703(97)70224-2","article-title":"Neonatal atrial flutter: Significant early morbidity and excellent long-term prognosis","volume":"133","author":"Casey","year":"1997","journal-title":"Am. Heart J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1007\/s00246-009-9413-6","article-title":"Elevated impedance during cardioversion in neonates with atrial flutter","volume":"30","author":"Ceresnak","year":"2009","journal-title":"Pediatr. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/BF00795370","article-title":"Pediatric Cardiology Atrial Tachycardia in Infants and Children: Electrocardiographic Classification and Its Significance","volume":"14","author":"Mehta","year":"1993","journal-title":"Pediatr. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/PCC.0b013e3181dbb4fc","article-title":"External and internal biphasic direct current Shock dosis for pediatric ventricular fibrillation and pulseless ventricular tachycardia","volume":"12","author":"Tibballs","year":"2011","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/0002-9149(88)90377-3","article-title":"Acute termination of supraventricular tachyarrhythmias in children by transesophageal atrial pacing","volume":"61","author":"Dick","year":"1988","journal-title":"Am. J. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1136\/adc.47.255.833","article-title":"Direct Current Cardioversion in a Case of Congenital Atrial Flutter","volume":"47","author":"Barclay","year":"1972","journal-title":"Arch. Dis. Child."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"E13","DOI":"10.1016\/j.jpedsurg.2010.05.013","article-title":"Induction of life-threatening supraventricular tachycardia during central venous catheter placement: An unusual complication","volume":"45","author":"Waisberg","year":"2010","journal-title":"J. Pediatr. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1542\/peds.112.3.677","article-title":"Fire Attributable to a Defibrillation Attempt in a Neonate","volume":"112","author":"Theodorou","year":"2003","journal-title":"Pediatrics"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1111\/j.1540-8159.2006.00551.x","article-title":"Low Energy Biphasic Waveform Cardioversion of Atrial Arrhythmias in Pediatric Patients and Young Adults","volume":"29","author":"Liberman","year":"2006","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_43","first-page":"306","article-title":"Ventricular Tachycardia during Repair of Gastroschisis","volume":"25","author":"Saidi","year":"1998","journal-title":"Tex. Heart Inst. J."},{"key":"ref_44","first-page":"846","article-title":"DC Cardioversion of supraventricular Tachycardia in Neonate","volume":"26","author":"Singh","year":"1989","journal-title":"Indian Pediatr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/S0025-6196(12)60214-6","article-title":"Refractory Supraventricular Tachycardia in the Neonate: Treatment with Temporary Antitachycardial Pacing","volume":"60","author":"Sugrue","year":"1985","journal-title":"Mayo Clin. Proc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1536\/ihj.39.287","article-title":"Atrial Flutter in the Neonate and Early Infancy","volume":"39","author":"Peng","year":"1998","journal-title":"Jpn. Heart J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1891\/0730-0832.36.5.313","article-title":"Atrial Flutter in the Neonate: A case Study","volume":"36","author":"Roumiantsev","year":"2017","journal-title":"Neonatal Netw."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/0002-8703(71)90083-4","article-title":"Congestive heart failure following chronic tachycardia","volume":"81","author":"Coleman","year":"1971","journal-title":"Am. Heart J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1055\/s-0034-1372430","article-title":"Diagnosis and treatment of fetal arrhythmia","volume":"31","author":"Strasburger","year":"2014","journal-title":"Am. J. Perinatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S53","DOI":"10.1002\/jcph.2129","article-title":"Fetal Arrhythmia Diagnosis and Pharmacologic Management","volume":"62","author":"Strasburger","year":"2022","journal-title":"J. Clin. Pharmacol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1093\/europace\/eut082","article-title":"Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement","volume":"15","author":"Brugada","year":"2013","journal-title":"Europace"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1053\/euhj.2002.3274","article-title":"Guidelines for the interpretation of the neonatal electrocardiogram: A Task Force of the European Society of Cardiology","volume":"23","author":"Schwartz","year":"2002","journal-title":"Eur. Heart J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/S1058-9813(00)00033-3","article-title":"Supraventricular tachycardia in neonate and infand","volume":"11","author":"Moak","year":"2000","journal-title":"Prog. Pediatr. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.resuscitation.2021.02.015","article-title":"European Resuscitation Council Guidelines 2021: Paediatric Life Support","volume":"161","author":"Turner","year":"2021","journal-title":"Resuscitation"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"S185","DOI":"10.1161\/CIR.0000000000000895","article-title":"Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations","volume":"142","author":"Wyckoff","year":"2020","journal-title":"Circulation"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"bcr2015214239","DOI":"10.1136\/bcr-2015-214239","article-title":"Neonatal ventricular fibrillation and an elusive ALCAPA: Things are not always as they seem","volume":"2016","author":"Walker","year":"2016","journal-title":"BMJ Case Rep."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.jacc.2022.06.038","article-title":"Clinical Predictors of Recurrent Supraventricular Tachycardia in Infancy","volume":"80","author":"Moore","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"753","DOI":"10.2174\/138161208784007644","article-title":"Pharmacological Therapy in Children with Atrioventricular Reentry: Which Drug?","volume":"14","author":"Ratnasamy","year":"2008","journal-title":"Curr. Pharm. Des."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1007\/s00246-022-03074-w","article-title":"Early and Late Postoperative Tachyarrhythmias in Children and Young Adults Undergoing Congenital Heart Disease Surgery","volume":"44","author":"Joye","year":"2023","journal-title":"Pediatr. Cardiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/5\/838\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:30:00Z","timestamp":1760124600000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/5\/838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,5]]},"references-count":60,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["children10050838"],"URL":"https:\/\/doi.org\/10.3390\/children10050838","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,5]]}}}