Pediatric Atrial Fibrillation Poses Rare, Serious Risks and Recurrence Rates

A recent study looks at how pediatric atrial fibrillation, a rare but serious health issue, has high recurrence rates.

Atrial fibrillation (AF) is characterized by a rapid and irregular heartbeat that most commonly causes chronic arrhythmia in adults but is rare in children. However, researchers found a nearly 40 percent recurrence rate in those who were younger, which caused more serious symptoms.

"Large population studies of adult patients with lone AF have found that the cumulative rate of progression to permanent AF is 19 percent at ten years and 29 percent at 30 years, but there are no similar data published for younger patients. Longer term follow-up studies of pediatric patients with lone AF are required to better understand the natural history specific to this population," lead investigator Shubhayan Sanatani, MD, Associate Professor, Division of Pediatric Cardiology, University of British Columbia, Vancouver said, via a press release.

Background information from the study shows that lone AF is defined as occurring in pateints with AF who are less than 60 years of age and do not suffer from other forms of cardiovascular disease or hypertension.

Four Centers from the Canadian Pediatric Electrophysiology Working Group  (Vancouver, Toronto, Edmonton, and Ottawa) examined patients that were eligible for the study, which resulted in the largest cohort of pediatric lone AF, according to a press release.

Researchers reviewed records from 1996 to 2011, identifying 42 patients with a first episode of lone AF. Four patients were later categorized as having persistent AF.

The investigators worked to describe their information via clinical characteristics, management strategies and recurrence rates in order to identify factors that might predict AF recurrence. They found that AF recurred in 15 to 38 patients (39 percent) in an estimated time span of 19 months. Such factors that determined a recurrence included longer duration of the initial episode and the reporting of frequent palpitations-either daily or weekly-after the initial episode.

There was a wide variation in management strategies used in both the acute treatment and outpatient management of AF, particularly in the treatment of the initial presenting episode.

Yet some things played no role in the possibility of recurrence, including sex, age, family history, size of the left atrium and a history of cardioversion.

Excluding patients with persistent AF, recurrence with another supraventricular tachyarrhythmia (SVT) was observed in 6 of 38 (16 percent) patients, which is possibly a predisposing factor for AF. Twelve patients underwent electrophysiology (EP) study, with six patients receiving ablation.

"In conclusion, although it appears to be a rare disease in pediatric patients, lone AF does carry a substantial burden of symptoms and has a high recurrence rate," comments Dr. Sanatani. "Our reported rate of recurrence of 39 percent is important when counseling pediatric patients and their families on the expected course and treatment goals. The specific management strategies in pediatric patients have still not been well defined, but there is a need for an organized and consistent approach. Pediatric practice should be in alignment with published adult guidelines. Long-term follow-up studies and larger series of pediatric patients with lone AF are required to better understand the natural history," he said, via the release.

More information regarding the study can be found via the Canadian Journal of Cardiology.