Management and outcomes of atrial fibrillation in 241 healthy children and young adults: Revisiting “lone” atrial fibrillation—A multi-institutional PACES collaborative study

Iqbal El Assaad, Benjamin H. Hammond, Lukas D. Kost, Sarah Worley, Christopher M. Janson, Elizabeth D. Sherwin, Elizabeth A. Stephenson, Christopher L. Johnsrude, Mary Niu, Ira Shetty, David Lawrence, Anthony C. McCanta, Seshadri Balaji, Shubhayan Sanatani, Frank Fish, Gregory Webster, Peter F. Aziz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Atrial fibrillation (AF) in healthy children and young adults is rare. Risk of recurrence and treatment efficacy are not well defined. Objective: The purpose of this study was to assess recurrence patterns and treatment efficacy in AF. Methods: A retrospective multicenter cohort study including 13 congenital heart centers was facilitated by the Pediatric & Congenital Electrophysiology Society (PACES). Patients ≤21 years of age with documented AF from January 2004 to December 2018 were included. Demographics, family and clinical history, medications, electrophysiological study parameters, and outcomes related to the treatment of AF were recorded and analyzed. Patients with contributory diseases were excluded. Results: In 241 subjects (83% male; mean age at onset 16 years), AF recurred in 94 patients (39%) during 2.1 ± 2.6 years of follow-up. In multivariable analysis, predictors of AF recurrence were family history in a first-degree relative <50 years of age (odds ratio [OR] 1.9; P = .047) and longer PR interval in sinus rhythm (OR 1.1 per 10 ms; P = .037). AF recurrence was similar whether patients began no treatment (39/125 [31%]), began daily antiarrhythmic therapy (24/63 [38%]), or had an ablation at any time (14/53 [26%]; P = .39). Ablating non-AF substrate with supraventricular tachycardia improved freedom from AF recurrence (P = .013). Conclusion: Recurrence of AF in the pediatric population is common, and the incidence of recurrence was not impacted by “no treatment,” “medication only,” or “ablation” treatment strategy. Ablation of pathways and other reentrant targets was the only intervention that decreased AF recurrence in children and young adults.

Original languageEnglish (US)
Pages (from-to)1815-1822
Number of pages8
JournalHeart rhythm
Volume18
Issue number11
DOIs
StatePublished - Nov 2021
Externally publishedYes

Keywords

  • Ablation
  • Atrial fibrillation
  • Children
  • Electrophysiological study
  • Reentry

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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