Lone Atrial Fibrillation Clinical Characteristics in Children

Child EKG
Child EKG
Children aged 15-19 years appear to have the greatest risk of developing lone atrial fibrillation.

Obesity, male sex, and older age are risk factors for developing lone atrial fibrillation (AF) in the pediatric population, according to a study published in Pediatric Cardiology.

Because lone AF, defined as “AF in the absence of cardiac or systemic disease,” is an uncommon condition in children, data on the associated risk factors and clinical characteristics are lacking. Although AF is more likely to develop in children with congenital heart disease, it has also been identified in otherwise healthy children. Older age and obesity are risk factors for AF in adults, but whether increasing age and childhood obesity also raise the risk for AF in children was unknown until recently.

Researchers, led by Peter F. Aziz, MD, and Iqbal El-Assaad, MD, from Cleveland Clinic Children’s Hospital in Ohio, examined the prevalence, risk factors, and recurrence rates of lone AF in children.

Lone AF was identified in 1570 of 7,969,230 children in a large healthcare database, for a prevalence of 7.5 cases per 100,000 children.

The risk for lone AF was higher with increasing age, with children aged 15 to 19 years at the greatest risk compared with children aged 0 to 4 years (adjusted odds ratio [aOR], 10.7; 95% CI, 8.7-13.2; P <.001). Boys were also more likely to develop AF than girls (aOR, 1.7; P <.001). Obesity, defined as body mass index (BMI) ≥95th percentile, was also a risk factor compared with normal BMI (aOR, 1.3; 95% CI, 1.1-1.5; P <.001).

Recurrence rates ranged from 15% at 1 month to 23% at 12 months from initial diagnosis of lone AF. Older children were more likely to experience lone AF recurrence, with a recurrence rate of 19% at 1 month among children aged 15 to 19 years (P <.001).

Stroke occurred in 30 (2%) patients within 1 year of being diagnosed with lone AF.

“Factors such as male gender and BMI predispose pediatric patients to [AF], an entity considered to be a nearly exclusive adult disease. Pediatric patients with [AF] are likely genetically predisposed to this condition, and recurrence risk is therefore not negligible,” Dr Aziz told Cardiology Advisor.

Although this study evaluated the clinical characteristics of lone AF in children, it did not measure outcomes of lone AF.

“Our study did not examine closely the response of treatment in this patient population,” Dr Aziz added. “Medical therapy and catheter ablation have been used historically, though data to demonstrate efficacy is not currently available. We are currently working on answering these important questions using our own institutional data in addition to launching an international registry to track outcomes in these patients.”

Study Limitations

  • Researchers did not have access to electrocardiograms or echocardiograms; therefore, patients were identified by the systemized nomenclature of medicine-clinical terms diagnostic code for AF.
  • Some patients, particularly the youngest group (aged 0-4 years), may have been misclassified as having AF because of supraventricular tachycardia.
  • Recurrence risk may be overestimated as a result of the diagnostic code repeated in the patients’ electronic health records.

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El-Assaad I, Al-Kindi SG, Saarel EV, Aziz PF. Lone pediatric atrial fibrillation in the United States: analysis of over 1500 cases [published online April 3, 2017]. Pediatr Cardiol. doi:10.1007/s00246-017-1608-7