Author + information
- Received October 2, 2017
- Revision received February 6, 2018
- Accepted February 7, 2018
- Published online May 21, 2018.
- Matthew L. Furst, MDa,
- Elizabeth V. Saarel, MDa,
- Ayman A. Hussein, MDb,
- Oussama M. Wazni, MDb,
- Patrick Tchou, MDb,
- Mohamed Kanj, MDb,
- Walid I. Saliba, MDb and
- Peter F. Aziz, MDa,∗ ()
- aDepartment of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio
- bRobert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Sydell and Arnold Miller Heart & Vascular Institute, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Peter F. Aziz, Department of Pediatric Cardiology, Cleveland Clinic, Mail Code M41, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Objectives The goal of this study was to describe the clinical characteristics of pediatric patients with lone atrial fibrillation (LAF) and their treatment outcomes. The authors focused on patients who underwent ablation and compared the recurrence after ablation of supraventricular tachycardia substrates as presumed triggers versus pulmonary vein isolation (PVI).
Background LAF in pediatrics is rare, and outcomes remain poorly defined. Current guidelines on ablation are based on a few small studies, and we present outcomes from the largest cohort of patients after ablation.
Methods This retrospective review included patients ≤21 years of age diagnosed with LAF from 2004 to 2015. Relevant clinical data, including recurrence rates after treatment, were tracked and analyzed with a focus on patients who underwent ablation procedures.
Results Sixty-two patients were identified with LAF; 88% were male, and 63% were athletes. Of the 33 patients taking antiarrhythmic medication, 20 (61%) experienced recurrence. Overall, 16 patients (26%) underwent ablation: PVI in 10 (62.5%), ablation of an accessory pathway in 3 (19%), and modification of the slow atrioventricular nodal pathway in 3 (19%). One-half of patients who underwent PVI experienced documented recurrence. Of those who solely underwent supraventricular tachycardia substrate ablation, one-half also had symptomatic or documented recurrence.
Conclusions Ablation recurrence within this pediatric cohort was higher than expected. These recurrence rates may be demonstrative of the technical challenge of pediatric ablation compared with adult counterparts, characteristics of these patients such as athletic conditioning, or inherent differences in their atrial tissue, rendering it more refractory to substrate modification.
- atrioventricular nodal re-entrant tachycardia
- atrioventricular re-entrant tachycardia
- lone atrial fibrillation
- pulmonary vein isolation
Dr. Saliba has received speaker fees honoraria from Boston Scientific and Biosense Webster. All other authors have reported that they have no other relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received October 2, 2017.
- Revision received February 6, 2018.
- Accepted February 7, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.