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.

中文翻译：

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241 名健康儿童和青年房颤的管理和结果：重新审视“孤立”房颤——一项多机构 PACES 合作研究

背景

健康儿童和年轻人的心房颤动 (AF) 很少见。复发风险和治疗效果尚不明确。

客观的

本研究的目的是评估 AF 的复发模式和治疗效果。

方法

儿科和先天性电生理学会 (PACES) 促进了一项包括 13 个先天性心脏中心的回顾性多中心队列研究。纳入 2004 年 1 月至 2018 年 12 月期间记录为 AF 的≤21 岁的患者。记录和分析与 AF 治疗相关的人口统计学、家族和临床病史、药物治疗、电生理研究参数和结果。排除有促发疾病的患者。

结果

在 241 名受试者（83% 男性；平均发病年龄 16 岁）中，94 名患者（39%）在 2.1 ± 2.6 年的随访期间再次发生 AF。在多变量分析中，AF 复发的预测因素是一级亲属 <50 岁的家族史（优势比 [OR] 1.9；P  = .047）和窦性心律中较长的 PR 间期（OR 1.1/10 ms；P  = .037)。无论患者是否开始不治疗 (39/125 [31%])、开始每日抗心律失常治疗 (24/63 [38%]) 或在任何时间进行消融 (14/53 [26%]; P = .39)。用室上性心动过速消融非 AF 基质可改善 AF 复发率 ( P = .013)。

结论

AF 在儿科人群中的复发很常见，并且复发的发生率不受“不治疗”、“仅药物治疗”或“消融”治疗策略的影响。通路和其他折返靶点的消融是减少儿童和年轻人 AF 复发的唯一干预措施。