Review of atrial fibrillation for the general paediatrician.

Paediatric atrial fibrillation (AF) is an infrequent entity in the absence of congenital heart disease as children are unlikely to have the structural and functional changes in their myocardium to sustain the arrhythmia. Any child presenting with this arrhythmia needs to be carefully evaluated for concealed cardiac pathology such as cardiomyopathy or inherited arrhythmia syndromes. AF leading to a haemodynamically unstable patient is rare and should prompt synchronised cardioversion, while stable patients can be discussed with a paediatric cardiologist. Tachycardia-induced cardiomyopathy and thromboembolism are possible complications of sustained AF and anticoagulation is usually indicated to prevent the latter. Risk of AF increases with age and body mass index. Obesity and athletics are known risk factors and recurrence can be seen even in the absence of any identifiable underlying pathology.