359 Lone atrial fibrillation in the pediatric population

Abstract

Atrial Fibrillation (AF) is the most common chronic arrhythmia in adults but is seldom observed in the pediatric population. The purpose of this study was to examine patient demographics, clinical features, and the treatment strategies of lone AF in pediatric patients. Five Canadian centres identified patients for retrospective analysis that presented with AF from the period of January/1996 until August/2010. Patients ≤18 years of age at presentation with Lone AF were included. AF was documented by electrocardiogram (ECG), 24-hour Holter, or rhythm strip. Exclusion criteria consisted of perioperative AF; coexisting congenital heart disease or thyroid disease; and pre-excitation documented on ECG or at electrophysiologic study. Demographics, clinical presentation, investigations, and treatment were analyzed. Forty patients who met criteria for lone AF were identified. The median age at presentation 15.5 yrs and 33/40 patients were male. Symptoms at presentation consisted of palpitations (32/40), chest pain (12/40), shortness of breath (12/40) and syncope (8/40). Electrical cardioversion was used in 7/40 patients; with concomitant antiarrhythmic medication in 3 of these patients. Pharmaceutical cardioversion was used in 8 patients, consisting of digoxin (n = 4), propafenone (n = 2), and procainamide (n = 2). B-blocker therapy was used in 8 patients (atenolol (6/8), esmolol (1/8) and metoprolol (1/8)). Five patients underwent ablation. Recurrence occurred in 4 patients; 3/4 patients were on medication (sotalol (n = 1) b-blocker (n = 1), and digoxin (n = 1)). 3 patients continued to be in chronic AF. Maintenance medications included atenolol (n = 4), digoxin (n = 7), sotalol (n = 3), amiodarone (n = 1), flecainide (n = 2), and propafenone (n = 1). Pill in a pocket medication was used in 2 patients, consisting of propafenone in both patients. Thrombus was found at presentation in 2 patients; 1 patient was asymptomatic and 1 patient initally presented with a MCA stroke. Initial anticoagulation in all patients included heparin (n = 7), ASA (n = 9) and coumadin (n = 4). Long-term antiocoagulation consisted of coumadin (n = 3) and aspirin (n = 4). Lone AF is an uncommon arrhythmia in the pediatric age group but can be difficult to treat and does carry with it similar comorbidities as in the adult population. Important clinical features include a high prevalence of males, as well as presenting symptoms of palpitations, chest pain, and syncope. Treatment options for AF are numerous but have yet to be standardized in the pediatric population.