Electrophysiological Findings in Adolescents With Atrial Fibrillation Who Have Structurally Normal Hearts

Abstract

Background-Atrial fibrillation (AF) is uncommon in children, and its mechanisms are unknown. This study describes the electrophysiological findings in children and adolescents with AF and the outcome of catheter ablation. Methods and Results-Nine adolescents with symptomatic, lone AF who failed antiarrhythmic drug therapy were evaluated. All patients had ECG-documented AF and underwent invasive electrophysiological testing. Intracardiac mapping was performed to determine the site of spontaneous onset of AF and rapidly firing atrial foci. Only the triggering focus was targeted for ablation or isolation. The patients' mean age was 15.9Ϯ3.3 (range, 8 to 19 years). The most common finding was rapid, irregular atrial tachycardias in the region of the pulmonary veins (nϭ5), left atrium (nϭ2), or crista terminalis (nϭ3). One patient had foci in both the pulmonary veins and crista terminalis. The cycle lengths ranged from 108 to 280 ms. Catheter ablation was acutely successful in 8 patients (88.9%), whereas 1 patient with multiple left atrium foci was treated with the surgical maze operation. Over a mean of 35Ϯ22 months, 7 patients (77.8%) were arrhythmia free on no medications, while AF recurred in 2 patients who are controlled on antiarrhythmic medications. Two patients with tachycardia-induced cardiomyopathy had resolution of their left ventricular dysfunction after ablation. Conclusions-AF in adolescents with structurally normal hearts is usually due to foci in the pulmonary veins, crista terminalis, or left atrium. These foci usually induce irregular atrial tachycardias. Catheter ablation of the foci is effective in eliminating recurrent AF.

Pulmonary veins stenosis relief after an inappropriate radiofrequency catheter ablation of atrial fibrillation in a young non-competitive athlete

“…Although initial management should be conservative, in some cases during adolescence, the arrhythmia typically recurs multiple times despite medical therapy, creating a need for ablation therapy similar to the scenario in adults. The use of catheter ablation as been reported for paroxysmal supraventricular tachycardia and atrial fibrillation in young patients [7][8]. …”

Cold-Induced, Swallow-Related Atrial Fibrillation in an Adolescent

“…13 Abnormal atrial foci have been described in the pulmonary veins, crista terminalis, and left atrium. 14 Consequently, an EP study has been recommended for all children presenting with paroxysmal atrial fibrillation. 13,14 Though it was not indicated by the history in the case described herein, children and adolescents presenting with atrial fibrillation may require further laboratory studies for diagnostic evaluation.…”

Should Catheter Ablation of Atrial Fibrillation Be a First-Line Therapy in the Young?

“…Notably, a very small series of adolescent patients from 2004 had similar outcomes to those reported by these authors, including no adverse events. 3 Several weaknesses of this new report unnecessarily magnify the limitations of interpreting data from a single center. First, the authors do not reveal the average age or age range of the patients within the groups.…”