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Canadian Journal of Cardiology

Lone Atrial Fibrillation in the Pediatric Population

      Abstract

      Background

      There are few reports of pediatric studies of atrial fibrillation (AF). We sought to describe the clinical characteristics, management strategies, and recurrence rates and to identify predictors of AF recurrence in a contemporary pediatric population.

      Methods

      A retrospective review was performed of patients ≤ 18 years with lone AF who were seen at 4 pediatric institutions from 1996-2011. Patients with AF in the setting of thyroid disease, ventricular pre-excitation, coexisting congenital heart disease, or a history of cardiac surgery were excluded. Demographics, clinical presentation, investigations, treatment, and follow-up were analyzed.

      Results

      Forty-two patients were diagnosed with a first episode of lone AF, and 4 of these cases were later classified as persistent AF. Thirty-one (74%) were male patients, median age was 15.3 years, and median (interquartile range [IQR]) duration of AF episode was 12 (IQR, 7-24) hours. AF recurred in 39% (15 of 38) of patients. The Kaplan-Meier median time to estimated recurrence was 19 months. By univariate analysis, initial AF episode duration was associated with a higher risk of recurrence (hazard ratio [HR], 1.01; 95% confidence interval [CI], 1-1.02; P = 0.034). Sex, age, family history, size of the left atrium, and history of cardioversion were not associated with recurrence. Recurrence with another supraventricular tachyarrhythmia (SVT) was observed in 6 of 38 (16%) patients, and 12 patients underwent electrophysiology (EP) study, with 6 patients receiving ablation.

      Conclusions

      Our reported rate of recurrence of 39% is important when counseling pediatric patients and their parents on the expected course and treatment goals.

      Résumé

      Introduction

      Peu d’études pédiatriques sur la fibrillation auriculaire (FA) sont rapportées. Nous avons cherché à décrire les caractéristiques cliniques, les stratégies de prise en charge et les taux de récidive, et à déterminer les prédicteurs de récidive de la FA dans la population pédiatrique actuelle.

      Méthodes

      Une revue rétrospective a été réalisée chez des patients de ≤ 18 ans ayant une FA idiopathique qui ont été observés dans 4 établissements pédiatriques de 1996 à 2011. Les patients ayant une FA dans le cadre d’une maladie de la thyroïde, d’une préexcitation ventriculaire, de la coexistence d’une cardiopathie congénitale, ou ayant des antécédents de chirurgie cardiaque ont été exclus. La démographie, le tableau clinique, les examens, le traitement et le suivi ont été analysés.

      Résultats

      Quarante-deux (42) patients ont reçu le diagnostic d’un premier épisode de FA idiopathique, et 4 de ces cas ont été classifiés plus tard comme ayant une FA persistante. Trente-et-un (31; 74 %) étaient des patients de sexe masculin dont l’âge médian était de 15,3 ans et la durée médiane était de 12 (intervalle interquartile [IQ], 7-24) heures. La FA est réapparue chez 39 % (15 de 38) des patients. La durée médiane pour estimer la récidive selon Kaplan-Meier a été de 19 mois. Par l’analyse univariée, la durée de l’épisode initiale de FA a été associée à un risque plus élevé de récidive (rapport de risque [RR], 1,01; intervalle de confiance [IC] à 95 %, 1-1,02; P = 0,034). Le sexe, l’âge, les antécédents familiaux, la taille de l’oreillette gauche et les antécédents de cardioversion n’ont pas été associés à la récidive. La récidive d’une autre tachyarythmie supraventriculaire (TSV) a été observée chez 6 des 38 (16 %) patients, et 12 patients ont subi une étude électrophysiologique (ÉÉP), et 6 ont subi une ablation.

      Conclusions

      Notre taux de récidive rapporté de 39 % est important lorsque nous conseillons les patients pédiatriques et leurs parents sur l’évolution et les objectifs attendus du traitement.
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