Seshadri Balaji1, Jack Kron2, Eric C Stecker2. 1. Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon. 2. Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
Abstract
BACKGROUND: Atrial fibrillation (AF) is rare in teenagers. There are few reports and no clear guidelines on the management of AF with catheter ablation in teenagers. METHODS: A case series of teenagers (<18 years) with paroxysmal AF and a structurally normal heart who underwent catheter ablation was undertaken. RESULTS: Four teenage boys aged 15-17 years underwent catheter ablation of AF. All but one had failed antiarrhythmic medical therapy. Two had focal triggers and underwent culprit vein isolation (one recurred and so underwent isolation of an additional vein), and two had no focal triggers identified and so underwent isolation of all four pulmonary veins (PVs). At follow-up ranging from 2-6 years, one patient who underwent isolation of all four veins had recurrence of paroxysmal AF. All others have had medium and long-term success with complete absence of AF. None are on long-term antiarrhythmic therapy. No patient had a procedural or postprocedure complication. CONCLUSIONS: A cautious attempt at catheter ablation may be appropriate in teenagers with paroxysmal AF and a structurally normal heart who fail pharmacologic therapy. Culprit vein(s) isolation should be preferred if possible but if no focal triggers are identified, isolation of all PVs appears to be beneficial.
BACKGROUND:Atrial fibrillation (AF) is rare in teenagers. There are few reports and no clear guidelines on the management of AF with catheter ablation in teenagers. METHODS: A case series of teenagers (<18 years) with paroxysmal AF and a structurally normal heart who underwent catheter ablation was undertaken. RESULTS: Four teenage boys aged 15-17 years underwent catheter ablation of AF. All but one had failed antiarrhythmic medical therapy. Two had focal triggers and underwent culprit vein isolation (one recurred and so underwent isolation of an additional vein), and two had no focal triggers identified and so underwent isolation of all four pulmonary veins (PVs). At follow-up ranging from 2-6 years, one patient who underwent isolation of all four veins had recurrence of paroxysmal AF. All others have had medium and long-term success with complete absence of AF. None are on long-term antiarrhythmic therapy. No patient had a procedural or postprocedure complication. CONCLUSIONS: A cautious attempt at catheter ablation may be appropriate in teenagers with paroxysmal AF and a structurally normal heart who fail pharmacologic therapy. Culprit vein(s) isolation should be preferred if possible but if no focal triggers are identified, isolation of all PVs appears to be beneficial.
Authors: 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 Journal: Heart Rhythm Date: 2021-07-31 Impact factor: 6.779