Outcomes in Pediatric Lone Atrial Fibrillation

May 03, 2018
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Authors:
Furst ML, Saarel EV, Hussein AA, et al.
Citation:
Medical and Interventional Outcomes in Pediatric Lone Atrial Fibrillation. JACC Clin Electrophysiol 2018;May 2:[Epub ahead of print].
Summary By:
Martin LaPage, MD, FACC

Study Questions:

What is the outcome after treatment of atrial fibrillation (AF) in pediatric patients with normal hearts?

Methods:

This was a single-center retrospective cohort study of patients <22 years of age who presented with AF, but without other cardiac disease (“lone AF”) to the Cleveland Clinic from 2004-2015.

Results:

Findings in this cohort of 62 patients include: 1) 41 of the 54 patients untreated after the initial episode had a recurrence; 2) an electrophysiology study in 16 found a discrete supraventricular tachycardia (SVT) substrate in six, notably; Wolff-Parkinson-White syndrome patients were excluded from the study; 3) AF recurred in 50% of the six patients undergoing SVT substrate ablation, and 4) 10 patients with recurrent AF underwent AF targeted ablation, with a post-ablation recurrence of 50%.

Conclusions:

The authors concluded that outcomes of management for pediatric AF including observation, medication, or ablation have a high recurrence rate.

Perspective:

This retrospective study on pediatric AF reconfirms the findings of prior studies. The expected limitations retrospectively are perhaps more pronounced given the small number of subjects in each of the varied management approaches. One important question yet to answer is whether an adult or a pediatric electrophysiologist is more likely to deliver an optimal ablation outcome in this uncommon patient population.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Quality Improvement

Keywords: Ablation Techniques, Arrhythmias, Cardiac, Atrial Fibrillation, Cardiac Electrophysiology, Pediatrics, Recurrence, Secondary Prevention, Tachycardia, Supraventricular, Treatment Outcome, Wolff-Parkinson-White Syndrome


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