a fib in children

  My 11 y/o  son underwent an ablation for what we thought was wpw. During the mapping no extra pathways were found. My son showed no signs of wpw, but rather a fib. I understand that a fib is fairly uncommon in children. There are no other heart conditions we know of, and thyroid tests came back good. I can't seem to find anything on a fib in children, and could really use some help. What could cause this, and is there a chance he could outgrow it, or could it get worse?  If he was to out grow it  how would we know?  If he doesn't outgrow this what does his future hold?
  Thanks for you help.  Chris
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Dear Angela,
Thank you for your question.   Atrial fibrillation in children is rare but not unheard of.  Usually a source is looked for and if none if found empiric treatment started.  I have attached two recent articles on this topic that your local medical library should be able to help you obtain.

Unique Identifier
98053179
Authors
Luedtke SA.  Kuhn RJ.  McCaffrey FM.
Institution
University of Kentucky Children's Hospital, Lexington, USA.
Title
Pharmacologic management of supraventricular tachycardias in children. Part 2: Atrial flutter, atrial fibrillation, and junctional and atrial ectopic tachycardia. [Review] [114 refs]
Source
Annals of Pharmacotherapy.  31(11):1347-59, 1997 Nov.
Abstract
OBJECTIVE: To review the literature regarding the use of antiarrhythmic agents in the management of atrial flutter (AF), atrial fibrillation (Afib), junctional ectopic tachycardia (JET), and atrial ectopic tachycardia (AET) in infants and children. To discuss the advantages and disadvantages of specific agents in each type of arrhythmia in an effort to develop treatment guidelines. DATA SOURCE: A MEDLINE search encompassing the years 1966-1996 was used to identify pertinent literature for discussion. Additional references were found in the articles, which were retrieved via MEDLINE. STUDY SELECTION: Clinical trials that address the use of antiarrhythmic agents for the treatment of supraventricular tachycardia, AF, Afib, JET, and AET in children were selected. Literature pertaining to dosage, pharmacokinetics, efficacy, and toxicity of antiarrhythmic agents in children were considered for possible inclusion in the review; information judged to be pertinent by the authors was included in the discussion. DATA EXTRACTION: Although there are numerous reports of antiarrhythmic use in children, there are very few large studies designed that evaluate the use of specific antiarrhythmic agents in the treatment of AF, Afib, JET, or AET. Ideally, controlled clinical trials are used to develop clinical guidelines; however, in this situation, most data and information must be obtained from case series of children treated. Although the results from these types of studies may be useful in developing guidelines for the optimal use of these agents for the treatment of AF, Afib, JET, and AET, controlled trials are required for establishing standard treatment guidelines for all patients. DATA SYNTHESIS: Despite limited scientific evaluation of conventional agents in the treatment of AF, Afib, JET, or AET in children, they continue to be the standards of care. Most information regarding the use of conventional agents in children has been extrapolated from the adult literature. Little justification for the use of the agents or dosing in children is available. Controlled trials regarding the use of newer antiarrhythmic agents (propafenone, amiodarone, flecainide) are available; however, the variance in dosing schemes, presence of structural heart disease, and patient age may confound the results. CONCLUSIONS: Because of greater clinical experience, conventional antiarrhythmic agents generally remain as first-line therapy in the management of most supraventricular tachycardias in children. Atrial pacing or cardioversion to reestablish sinus rhythm is indicated for initial episodes of AF in infants, followed by chronic prophylactic therapy in those with significant structural heart disease or in infants in whom AF recurs. Attempts to eliminate AF in children outside the neonatal or infancy period should begin with trials of traditional agents such as digoxin or procainamide, and if unsuccessful, subsequent trials of amiodarone. Digoxin and beta-blockers remain the mainstay of therapy for children with Afib, followed by procainamide for treatment failures. Intravenous amiodarone, the newest addition to our antiarrhythmic armamentarium, is the most promising agent in the treatment of postoperative JET. This arrhythmia has been traditionally managed with corporal cooling and/or digoxin therapy; however, intravenous amiodarone may now be a valuable option. Although relatively unsuccessful in the management of congenital JET and AET, conventional agents are typically used prior to the initiation of long-term therapy with potentially more toxic agents such as amiodarone or propafenone. Additional well-designed, controlled trials are needed to further evaluate the comparative efficacy of agents such as flecainide, sotalol, moricizine, propafenone, and amiodarone in the management of AF, Afib, JET, and AET in children, as well as to evaluate the dosing and toxicity in various age groups. [References: 114]

Unique Identifier
96166680
Authors
Gow RM.
Institution
Hospital for Sick Children, Toronto, Ontario.
Title
Atrial fibrillation and flutter in children and in young adults with congenital heart disease. [Review] [40 refs]
Source
Canadian Journal of Cardiology.  12 Suppl A:45A-48A, 1996 Jan.

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