Iqbal El Assaad1, Benjamin H Hammond2, Lukas D Kost2, Sarah Worley2, Christopher M Janson3, Elizabeth D Sherwin4, Elizabeth A Stephenson5, Christopher L Johnsrude6, Mary Niu7, Ira Shetty8, David Lawrence9, Anthony C McCanta10, Seshadri Balaji11, Shubhayan Sanatani12, Frank Fish13, Gregory Webster14, Peter F Aziz15. 1. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts. 2. Division of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio. 3. Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 4. Division of Cardiology, Children's National Health System, Washington, DC. 5. Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada. 6. Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky. 7. Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah. 8. Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois. 9. Division of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, Michigan. 10. Department of Pediatric Cardiology, University of California-Irvine and Children's Hospital of Orange County, Orange, California. 11. Division of Pediatric Cardiology, Oregon Health and Science University, Portland, Oregon. 12. Children's Heart Centre, BC Children's Hospital, University of British Columbia, Vancouver, Canada. 13. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. 14. Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. 15. Division of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio. Electronic address: azizp@ccf.org.
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.
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.
Authors: Matthew L Furst; Elizabeth V Saarel; Ayman A Hussein; Oussama M Wazni; Patrick Tchou; Mohamed Kanj; Walid I Saliba; Peter F Aziz Journal: JACC Clin Electrophysiol Date: 2018-05-02
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