Lone Atrial Fibrillation in the Young - Perhaps Not So "Lone"?

Objective To 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 design A 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. Results Eighteen 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. Conclusions Inducible 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. (J Pediatr 2013;162:827-31).