JACC. Clinical electrophysiology · 2018
Medical and Interventional Outcomes in Pediatric Lone Atrial Fibrillation.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Furst Matthew L, Saarel Elizabeth V, Hussein Ayman A, Wazni Oussama M, Tchou Patrick, Kanj Mohamed, Saliba Walid I, Aziz Peter F
Аннотация
OBJECTIVES: The goal of this study was to describe the clinical characteristics of pediatric patients with lone atrial fibrillation (LAF) and their treatment outcomes. The authors focused on patients who underwent ablation and compared the recurrence after ablation of supraventricular tachycardia substrates as presumed triggers versus pulmonary vein isolation (PVI).
BACKGROUND: LAF in pediatrics is rare, and outcomes remain poorly defined. Current guidelines on ablation are based on a few small studies, and we present outcomes from the largest cohort of patients after ablation.
METHODS: This retrospective review included patients ≤21 years of age diagnosed with LAF from 2004 to 2015. Relevant clinical data, including recurrence rates after treatment, were tracked and analyzed with a focus on patients who underwent ablation procedures.
RESULTS: Sixty-two patients were identified with LAF; 88% were male, and 63% were athletes. Of the 33 patients taking antiarrhythmic medication, 20 (61%) experienced recurrence. Overall, 16 patients (26%) underwent ablation: PVI in 10 (62.5%), ablation of an accessory pathway in 3 (19%), and modification of the slow atrioventricular nodal pathway in 3 (19%). One-half of patients who underwent PVI experienced documented recurrence. Of those who solely underwent supraventricular tachycardia substrate ablation, one-half also had symptomatic or documented recurrence.
CONCLUSIONS: Ablation recurrence within this pediatric cohort was higher than expected. These recurrence rates may be demonstrative of the technical challenge of pediatric ablation compared with adult counterparts, characteristics of these patients such as athletic conditioning, or inherent differences in their atrial tissue, rendering it more refractory to substrate modification.
BACKGROUND: LAF in pediatrics is rare, and outcomes remain poorly defined. Current guidelines on ablation are based on a few small studies, and we present outcomes from the largest cohort of patients after ablation.
METHODS: This retrospective review included patients ≤21 years of age diagnosed with LAF from 2004 to 2015. Relevant clinical data, including recurrence rates after treatment, were tracked and analyzed with a focus on patients who underwent ablation procedures.
RESULTS: Sixty-two patients were identified with LAF; 88% were male, and 63% were athletes. Of the 33 patients taking antiarrhythmic medication, 20 (61%) experienced recurrence. Overall, 16 patients (26%) underwent ablation: PVI in 10 (62.5%), ablation of an accessory pathway in 3 (19%), and modification of the slow atrioventricular nodal pathway in 3 (19%). One-half of patients who underwent PVI experienced documented recurrence. Of those who solely underwent supraventricular tachycardia substrate ablation, one-half also had symptomatic or documented recurrence.
CONCLUSIONS: Ablation recurrence within this pediatric cohort was higher than expected. These recurrence rates may be demonstrative of the technical challenge of pediatric ablation compared with adult counterparts, characteristics of these patients such as athletic conditioning, or inherent differences in their atrial tissue, rendering it more refractory to substrate modification.