Prevalence of Atrial Fibrillation in Pediatric Patients
Atrial fibrillation (AF) is rare in the pediatric population, with prevalence increasing with age from less than 1% in children under 1 year to approximately 10-12% in older adolescents with cardiac arrest. 1
Epidemiology by Age Group
- Ventricular fibrillation (VF) and other tachyarrhythmias like AF are uncommon in infants but increase in frequency with age 1
- In infants under 1 year of age, VF/AF is an uncommon cause of out-of-hospital cardiac arrest, with rates of 6-10% when including SIDS cases 1
- When SIDS cases are excluded, the prevalence increases to 19-24% in pediatric out-of-hospital cardiac arrests 1
- In-hospital studies show initial VF in approximately 11-12% of pediatric cardiac arrests, with VF/VT occurring at some point during 20-25% of pediatric arrests 1
Prevalence by Clinical Context
- Atrial flutter accounts for approximately 30% of fetal tachyarrhythmias, 11-18% of neonatal tachyarrhythmias, and 8% of supraventricular tachyarrhythmias in children older than 1 year 2
- AF specifically is much less common than atrial flutter in the pediatric population 2
- In a multicenter retrospective study of patients under 25 years with AF/atrial flutter, the median age was 17 years 3
Associated Conditions
- Structural heart disease is present in approximately 57% of pediatric/young adult AF cases 3
- Primary cardiomyopathy is found in about 10% of pediatric/young adult AF cases 3
- In children with congenital heart disease (CHD), AF is seen in approximately 20% of cases requiring cardioversion, though intra-atrial reentrant tachycardia and atrial flutter are more common 1
- Surgical correction of congenital heart lesions is directly related to the development of AF in many pediatric cases 4
- Male predominance (74%) and obesity are risk factors for AF in pediatric patients, similar to adults 5
Clinical Implications
- AF is the arrhythmia associated with improved survival rates in most studies of children with cardiac arrest compared to asystole/pulseless electrical activity 1
- Thromboembolic complications occur in pediatric AF/atrial flutter patients, with the majority associated with structural heart disease, cardiomyopathy, and/or ventricular dysfunction 3
- In a study of 35 pediatric AF cases, 3 children experienced cerebral emboli with residual defects 4
- Adult risk assessment tools like CHADS₂ and CHA₂DS₂-VASc scores have limited utility in the pediatric population 1, 3
Diagnostic Considerations
- Approximately 21-26% of pediatric AF patients may have additional electrophysiologic substrates (like AVRT or AVNRT) that could be amenable to ablation 5
- Successful ablation of these additional substrates can result in no further clinical episodes of AF in some pediatric patients 5
- Complete electrophysiologic evaluation should be considered in pediatric patients presenting with AF to identify potentially treatable underlying mechanisms 5