Catheter Ablation of Primary Supraventricular Tachycardia Substrate Presenting as Atrial Fibrillation in Adolescents

Background. Atrial fibrillation is rarely encountered in children and adolescents, and these cases are usually secondary to myocardial diseases, electrical abnormalities, or scar related in postoperative congenital heart disease patients. Untreated sustained atrial fibrillation may lead to tachycardia-induced cardiomyopathy and/or systemic thromboembolization. Objective. The objective here is to describe our findings in four adolescent patients presenting with recurrent atrial fibrillation. Design. We report here the results of the findings in four patients who presented with recurrent clinical atrial fibrillation. Results. Each of the four underwent electrophysiologic study that revealed a primary reentry or automatic supraventricular tachycardia (SVT) substrate, which was able to be treated with radiofrequency ablation. In three of the four cases, elimination of the primary substrate prevented subsequent recurrence of SVT symptoms or documented SVT and/or atrial fibrillation. Conclusion. Children and adolescents presenting with atrial fibrillation warrant an exhaustive search for a treatable primary cause of myocardial or electrical disease. If present, a primary SVT substrate may be successfully ablated to prevent recurrence of atrial fibrillation and any associated complications. Pulmonary vein isolation is rarely indicated in adolescents and should be avoided.