Division of Pediatric Cardiology, University of Ottawa, Ottawa, Ontario, Canada.
Can J Cardiol. 2013 Oct;29(10):1227-33. doi: 10.1016/j.cjca.2013.06.014.
There are few reports of pediatric studies of atrial fibrillation (AF). We sought to describe the clinical characteristics, management strategies, and recurrence rates and to identify predictors of AF recurrence in a contemporary pediatric population.
A retrospective review was performed of patients ≤ 18 years with lone AF who were seen at 4 pediatric institutions from 1996-2011. Patients with AF in the setting of thyroid disease, ventricular pre-excitation, coexisting congenital heart disease, or a history of cardiac surgery were excluded. Demographics, clinical presentation, investigations, treatment, and follow-up were analyzed.
Forty-two patients were diagnosed with a first episode of lone AF, and 4 of these cases were later classified as persistent AF. Thirty-one (74%) were male patients, median age was 15.3 years, and median (interquartile range [IQR]) duration of AF episode was 12 (IQR, 7-24) hours. AF recurred in 39% (15 of 38) of patients. The Kaplan-Meier median time to estimated recurrence was 19 months. By univariate analysis, initial AF episode duration was associated with a higher risk of recurrence (hazard ratio [HR], 1.01; 95% confidence interval [CI], 1-1.02; P = 0.034). Sex, age, family history, size of the left atrium, and history of cardioversion were not associated with recurrence. Recurrence with another supraventricular tachyarrhythmia (SVT) was observed in 6 of 38 (16%) patients, and 12 patients underwent electrophysiology (EP) study, with 6 patients receiving ablation.
Our reported rate of recurrence of 39% is important when counseling pediatric patients and their parents on the expected course and treatment goals.
目前鲜有儿科心房颤动（房颤）研究的报道。我们旨在描述一个当代儿科人群中心律失常的临床特征、管理策略、复发率，并确定房颤复发的预测因素。
对 1996 年至 2011 年间在 4 家儿科医疗机构就诊的、患有孤立性房颤且年龄不超过 18 岁的患者进行了回顾性分析。患有甲状腺疾病、心室预激、并存先天性心脏病或有心脏手术史的患者被排除在外。分析了患者的人口统计学、临床表现、检查、治疗和随访情况。
42 例患者被诊断为首次发作孤立性房颤，其中 4 例后来被归类为持续性房颤。31 例（74%）为男性患者，中位年龄为 15.3 岁，房颤发作的中位持续时间为 12（IQR，7-24）小时。38 例患者中有 15 例（39%）复发。通过单变量分析，初始房颤发作持续时间与更高的复发风险相关（风险比[HR]，1.01；95%置信区间[CI]，1-1.02；P=0.034）。性别、年龄、家族史、左心房大小和电复律史与复发无关。38 例患者中有 6 例（16%）出现另一种室上性心动过速（SVT）复发，12 例行电生理（EP）检查，其中 6 例行消融术。
当向儿科患者及其父母告知预期病程和治疗目标时，我们报告的 39%复发率是重要的。
