Lone Atrial Fibrillation in the Young - Perhaps Not So “Lone”?

ObjectiveTo determine if pediatric patients with a history of lone atrial fibrillation (AF) have other forms of supraventricular tachycardia (SVT) that may potentially trigger AF.Study designA multicenter review of patients with lone AF who underwent electrophysiology (EP) study from 2006-2011 was performed. Inclusion criteria: age ≤21 years, normal ventricular function, structurally normal heart, history of AF, and EP study and/or ablation performed. Exclusion criteria: congenital heart disease or cardiomyopathy. Patient demographics, findings at EP study and follow-up data were recorded.ResultsEighteen patients met inclusion criteria. The mean age was 17.9 ± 2.2 years, weight was 82 ± 21 kg, body mass index was 27 ± 6, and 15 (83%) were males. Eleven (61%) were overweight or obese. Seven (39%) had inducible SVT during EP study: 5 atrioventricular nodal re-entry tachycardia (71%) and 2 concealed accessory pathways with inducible atrioventricular re-entry tachycardia (29%). All 7 patients with inducible SVT underwent radiofrequency ablation. There were no complications during EP study and/or ablation for all 18 patients. The mean follow-up was 1.7 ± 1.5 years and there were no recurrences in the 7 patients who underwent ablation. There were 2 recurrences of AF in patients with no other form of SVT during EP study.ConclusionsInducible SVT was found in 39% of pediatric patients undergoing EP study for lone AF. EP study should be considered for pediatric patients presenting with lone AF.