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Published on: February 26, 2013
Prevalence, Management, and Outcomes of Atrial Fibrillation in Paediatric Patients: Insights from a Tertiary
Andreia Duarte Constante1,2, Joana Suarez1,2, Guilherme Lourenço1,2
1Pediatric Cardiology Department, Reference Center for Congenital Heart Diseases, Hospital de Santa Marta, Unidade Local de Saúde São José EPE, 1150-199 Lisbon, Portugal.
Insights
Atrial fibrillation (AF) in children is often linked to heart conditions, but effective rhythm control is achievable. Neurological complications, like stroke, are a concern, especially in those with underlying heart disease.
Area of Science:
- Cardiology
- Paediatric Medicine
- Electrophysiology
Background:
- Atrial fibrillation (AF) is increasingly diagnosed in paediatric populations.
- Management is challenging due to associations with underlying cardiac conditions.
- Understanding paediatric AF prevalence, treatment, and outcomes is crucial.
Purpose of the Study:
- To evaluate the prevalence of atrial fibrillation in paediatric patients.
- To assess management strategies and their efficacy.
- To determine outcomes and complication rates in paediatric AF.
Main Methods:
- Retrospective analysis of 36 paediatric patients (≤18 years) diagnosed with AF.
- Data collected on demographics, clinical presentation, treatments, and outcomes.
- Descriptive statistics used to analyze treatment efficacy, recurrence, and complications.
Main Results:
- Most paediatric AF cases were associated with acquired (52.8%) or congenital (16.7%) heart disease; 16.7% had lone AF.
- Rhythm control was successful in 96.2% of patients, with a 3.8% recurrence rate.
- Ischemic stroke was the most frequent complication (3 patients), all with rheumatic heart disease.
Conclusions:
- Paediatric AF is primarily linked to rheumatic and congenital heart diseases, but lone AF also occurs.
- While rhythm control is effective, neurological complications like stroke are significant concerns.
- Further research is needed to clarify aetiology, risk factors, and optimal management for paediatric AF.
Abstract:
Background and Objectives: Atrial fibrillation (AF) is increasingly recognised in paediatric patients, presenting unique challenges in management due to its association with various underlying heart conditions. This study aimed to evaluate the prevalence, management strategies, and outcomes of AF in this population. Materials and Methods: A retrospective analysis was conducted at a tertiary paediatric cardiology centre, including patients aged ≤18 years diagnosed with AF between January 2015 and December 2023. The study focused on demographic details, clinical presentations, treatments, and outcomes. Descriptive statistics were employed to assess treatment efficacy, recurrence rates, and complications. Results: The study included 36 paediatric patients (median age: 15 years, IQR: 13-17; 58% male). Of these, 52.8% had acquired heart disease, 16.7% had congenital heart anomalies, and 16.7% presented with lone AF. The initial management strategies involved electrical cardioversion in 53.3% of patients and pharmacological conversion with amiodarone in 46.7%. Rhythm control therapy was administered to over 80% of the cohort, and 63.9% were placed on oral anticoagulation, predominantly for rheumatic and congenital heart diseases. The overall success rate of rhythm control was 96.2%, with an AF recurrence rate of 3.8%. Ischemic stroke was the most common complication, occurring in three patients, all with underlying rheumatic heart disease. Conclusions: AF in paediatric patients is predominantly associated with rheumatic and congenital heart diseases, though a significant proportion of patients present with lone AF. Despite effective rhythm control in most cases, neurological complications, particularly ischemic strokes in patients with underlying heart disease, remain a critical concern. These findings underscore the need for more comprehensive studies to better understand the aetiology, risk factors, and optimal management strategies for paediatric AF.
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