Kristopher T Kang1, Susan P Etheridge1, Michal J Kantoch1, Svjetlana Tisma-Dupanovic1, David J Bradley1, Seshadri Balaji1, Robert M Hamilton1, Anoop K Singh1, Bryan C Cannon1, Michael S Schaffer1, James E Potts1, Shubhayan Sanatani2. 1. From the Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children's Hospital, Salt Lake City, UT (S.P.E.); Stollery Children's Hospital, Edmonton, AB, Canada (M.J.K.); Children's Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin, Milwaukee (A.K.S.); Mayo Clinic, Rochester, MN (B.C.C.); and The Children's Hospital Colorado, Aurora (M.S.S.). 2. From the Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada (K.T.K., J.E.P., S.S.); Primary Children's Hospital, Salt Lake City, UT (S.P.E.); Stollery Children's Hospital, Edmonton, AB, Canada (M.J.K.); Children's Mercy Hospital, Kansas City, MO (S.T.-D.); University of Michigan, Ann Arbor (D.J.B.); Oregon Health and Science University, Portland (S.B.); Hospital for Sick Children, Toronto, ON, Canada (R.M.H.); Medical College of Wisconsin, Milwaukee (A.K.S.); Mayo Clinic, Rochester, MN (B.C.C.); and The Children's Hospital Colorado, Aurora (M.S.S.). ssanatani@cw.bc.ca.
Abstract
BACKGROUND: Focal atrial tachycardia (FAT) is an uncommon cause of supraventricular tachycardia in children. Incessant FAT can lead to tachycardia-induced cardiomyopathy. There is limited information regarding the clinical course and management of FAT. This study characterizes current management strategies for FAT in children including the prevalence of spontaneous resolution and the role of catheter ablation. METHODS AND RESULTS: This is a retrospective chart review of pediatric patients with FAT managed between January 2000 and November 2010 at 10 pediatric centers. There were 249 patients with a median age at diagnosis of 7.2 (95% confidence interval, 5.8-10.4) years. Cardiomyopathy was observed in 28%. Resolution of FAT occurred in 89%, including spontaneous resolution without catheter ablation in 34%. Antiarrhythmic medications were used for initial therapy in 154 patients with control of FAT in 72%. Among first-line medications, β-blockers were the most common (53%) and effective (42%). Catheter ablation was successful in 80% of patients. FAT recurrence was less common with electroanatomic mapping compared with conventional mapping techniques (16% versus 35%; P=0.02). Patients were followed for a median of 2.1 (95% confidence interval, 1.8-2.6) years. CONCLUSIONS: FAT is managed successfully in most children. Current approaches are variable. Many patients have control of FAT with medications; however, catheter ablation is used for most patients. Spontaneous resolution is common for young children, emphasizing the role for delayed ablation in this group. Ablation is successful for all ages. Lower recurrence occurs when electroanatomic mapping techniques are used.
BACKGROUND: Focal atrial tachycardia (FAT) is an uncommon cause of supraventricular tachycardia in children. Incessant FAT can lead to tachycardia-induced cardiomyopathy. There is limited information regarding the clinical course and management of FAT. This study characterizes current management strategies for FAT in children including the prevalence of spontaneous resolution and the role of catheter ablation. METHODS AND RESULTS: This is a retrospective chart review of pediatric patients with FAT managed between January 2000 and November 2010 at 10 pediatric centers. There were 249 patients with a median age at diagnosis of 7.2 (95% confidence interval, 5.8-10.4) years. Cardiomyopathy was observed in 28%. Resolution of FAT occurred in 89%, including spontaneous resolution without catheter ablation in 34%. Antiarrhythmic medications were used for initial therapy in 154 patients with control of FAT in 72%. Among first-line medications, β-blockers were the most common (53%) and effective (42%). Catheter ablation was successful in 80% of patients. FAT recurrence was less common with electroanatomic mapping compared with conventional mapping techniques (16% versus 35%; P=0.02). Patients were followed for a median of 2.1 (95% confidence interval, 1.8-2.6) years. CONCLUSIONS: FAT is managed successfully in most children. Current approaches are variable. Many patients have control of FAT with medications; however, catheter ablation is used for most patients. Spontaneous resolution is common for young children, emphasizing the role for delayed ablation in this group. Ablation is successful for all ages. Lower recurrence occurs when electroanatomic mapping techniques are used.
Authors: Karine Guerrier; Pirouz Shamszad; Richard J Czosek; David S Spar; Timothy K Knilans; Jeffrey B Anderson Journal: Pediatr Cardiol Date: 2016-03-31 Impact factor: 1.655
Authors: Rakesh Gopinathannair; Susan P Etheridge; Francis E Marchlinski; Francis G Spinale; Dhanunjaya Lakkireddy; Brian Olshansky Journal: J Am Coll Cardiol Date: 2015-10-13 Impact factor: 24.094