title: Catheter ablation of primary supraventricular tachycardia substrate presenting as atrial fibrillation in adolescents.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Children's Healthcare of Atlanta Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia 30341, USA. strieperp@kidsheart.com
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Strieper
authors.forename: Patrick
authors.initials: P
authors.lastname: Frias
authors.forename: Peter
authors.initials: P
authors.lastname: Fischbach
authors.forename: Lynne
authors.initials: L
authors.lastname: Costello
authors.forename: Robert M
authors.initials: RM
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents