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Pediatric atrial fibrillation, though rare, is linked to various cardiac conditions and requires thorough investigation. Early diagnosis and treatment tailored to the underlying cause are crucial for managing this arrhythmia in children.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Pediatric Critical Care Medicine
Background:
- Atrial fibrillation (AF) is uncommon in pediatric populations.
- Historically associated with severe rheumatic heart disease and poor outcomes.
- This review examines a unique cohort of pediatric AF cases over 22 years.
Purpose of the Study:
- To review the clinical characteristics, associated conditions, and outcomes of atrial fibrillation in children.
- To understand the etiological factors and management strategies for pediatric AF.
- To highlight the importance of comprehensive evaluation for childhood AF.
Main Methods:
- Retrospective review of 35 pediatric cases of atrial fibrillation over 22 years.
- Analysis of patient demographics, age of onset, and associated cardiac conditions.
- Evaluation of treatment modalities and patient outcomes, including mortality and morbidity.
Main Results:
- The study included 35 children (23 boys), with onset from 1 day to 19 years (average 8 years).
- Common associated conditions included structural congenital heart malformations (17), cardiomyopathy (5), and paroxysmal atrial tachycardia of infants (4).
- Surgical correction of congenital heart lesions was linked to AF development in 14 patients; 21 had paroxysmal/transient AF, 14 persistent. Three children experienced cerebral emboli. 18 patients are alive, 13 deceased, 4 lost to follow-up.
Conclusions:
- Pediatric atrial fibrillation necessitates a complete diagnostic workup to identify underlying cardiac pathologies.
- Treatment should be individualized based on the specific etiology and clinical presentation.
- Early and appropriate management is vital for improving prognosis in children with atrial fibrillation.
Abstract:
Atrial fibrillation is rare in children. Previous reports associated it with severe rheumatic heart disease and a poor prognosis. This review is of the unique experience of 35 cases of atrial fibrillation in children in the past 22 years; 23 patients were boys. The age of onset ranged from 1 day to 19 years (average, 8 years). Associated cardiac conditions were severe rheumatic mitral regurgitation (3 cases), cardiomyopathy (5), atrial tumors (2), infective endocarditis (1), paroxysmal atrial tachycardia of infants (4), idiopathic paroxysmal atrial fibrillation (1), Marfan's syndrome with mitral regurgitation (1), endocardial fibroelastosis (1), and structural congenital heart malformations (17). Surgical correction of congenital heart lesions was directly related to the development of atrial fibrillation in 14. Varying arrhythmias of the sick-sinus syndrome were observed in five children. The atrial fibrillation was paroxysmal or transient in 21 patients and persistent in 14. Treatment depended on the underlying condition. Digoxin was used in all cases and cardioversion attempted in ten; no patient was given anticoagulants. Three children had cerebral emboli, with residual defects. Eighteen patients are known to be alive, 13 are dead, and 4 are lost to follow-up. Atrial fibrillation in childhood is an indication for complete investigation of the patient and for the institution of treatment appropriate to the underlying disease.