Abstract 14295: Asymptomatic Frequent Atrial Ectopy in Healthy Children and Adolescents

Abstract

Introduction: Premature atrial complexes (PACs) in pediatric patients with a structurally normal heart are usually presumed to be benign and self-resolving. On the contrary, adults with frequent PACs are at increased risk of multiple cardiovascular conditions. This study aims to evaluate a group of asymptomatic pediatric subjects with frequent PACs over time. Hypothesis: We hypothesized that, while most pediatric patients with frequent APCs have a benign prognosis there may be a subset that could progress to supraventricular arrhythmias Methods: Records for 343 pediatric patients (1-21 yrs) with asymptomatic frequent premature atrial complexes (>50/24 hours) were selected from 6902 pediatric patients that underwent Holters over a 10 year period. Demographics, pertinent clinical characteristics and results of cardiac investigations were tabulated. Comparisons were made between Holter results at presentation and follow-up. Patients were classified into two groups on follow-up, those with a significant (>20%) reduction in burden of atrial ectopy versus those with an insignificant (<20%) reduction or increase in burden of atrial ectopy. Results: The median age at initial Holter was 8.26 (1.3-20.9) years with a comparable male to female ratio. An irregular heart rate was the most common reason for a Holter. The most common preexisting medical condition was attention deficit disorder, followed by asthma. Follow-up Holters were performed on 188(54.8%) patients at a median of 2.2 (0.5-8) yrs after the first Holter. Overall there was a significant decrease in atrial ectopy burden on repeat Holter examinations; median 3.6% (0.03-18.7) to 0.5% (0-19) with 166 (88.3%) patients demonstrating a decrease in atrial ectopy by over 20% of baseline. Ten (5.3%) patients had an increase in the ectopy burden over time and 12(6.3%) had an insignificant change. Non sustained supraventricular tachycardia was noted in three patients on the initial Holter but none on subsequent evaluations. Multivariate analysis identified a higher initial burden of PACs as a strong independent predictor for reduction in burden of ectopy with time (p<0.005). Conclusions: Asymptomatic childhood PACs in the setting of a structurally normal heart are rare and tend to resolve with time.