New insights on the risk of atrial fibrillation in children and adolescents

Image Credit: PublicDomainPictures

Researchers at Karolinska Institutet have investigated the relationship between premature birth and fetal growth and the risk of developing atrial fibrillation up to middle age. The study, published in JAMA Pediatrics, shows a slightly increased risk, especially in people who were born prematurely or who were large at birth. Low fetal growth was associated with an increased risk of atrial fibrillation only up to the age of 18.

For a few decades, the prevalence of atrial fibrillation at a young age has increased slightly, albeit from low levels.

"Atrial fibrillation at a young age can impose a heavy socio-economic burden on the individual, and more knowledge is needed about the underlying causes of the disease. Our findings can highlight the need to monitor and prevent the disease in more groups with an increased risk of cardiovascular disease", said the study's first author Fen Yang, doctoral student at Department of Global Public Health, Karolinska Institutet.

Fen Yang.
Photo Credit: Julia Ortmann

About five percent of children born in Sweden are premature, ie born before week 37, according to the National Board of Health and Welfare. It was known before that premature babies and children who are unusually small and large at birth have a slightly increased risk of suffering from cardiovascular disease later in life such as ischemic heart disease, stroke and heart failure.

Low incidence in young people

So far, there has been little or contradictory information about the risk of atrial fibrillation in these groups. Atrial fibrillation increases the risk of stroke, among other things, and is the most common form of cardiac arrhythmia. Mainly middle-aged and older people are affected. The prevalence of young people is low and is estimated at 0.12–0.16 percent.

Researchers at Karolinska Institutet, among others, have studied the risk of premature children, as well as children who are born small and large to suffer from atrial fibrillation.

Krisztina László.
Photo Credit: János László

"We saw that for preterm infants and for children who were large for gestational age at birth, there was a slightly increased risk of atrial fibrillation up in the middle age. For children born small for gestational age, there is an increased risk of atrial fibrillation up to the age of 18 but not later in adulthood", said Krisztina László, associate professor at Department of Global Public Health, Karolinska Institutet and at the Department of Public Health and Care Sciences, Uppsala University, who led the study.

The risk increase was 30 percent for preterm infants, 55 percent for children who were large for gestational age at birth and 71 percent for children who were both preterm and large for gestational age at birth.

Study with eight million participants

The results are based on statistical analyzes of just over eight million births from Danish (1978-2016), Finnish (1987-2014) and Swedish (1973-2014) medical birth register. These were matched against the presence of atrial fibrillation in the national patient and cause of death registries until 2021. The results have been compared with the siblings in the same families. Since it is an observational study, it cannot establish any causal relationship.

In a next step, researchers want to study the relationship between premature birth, fetal growth and the risk of atrial fibrillation among the elderly.

Funding: The research was mainly funded by the Research Council for Health, Work Life and Welfare (FORTE), Karolinska Institutet's foundations and funds, the Hjärt-Lung Foundation and China's Scholarship Council. The researchers report no conflicts of interest.

Published in journal: JAMA Pediatrics

Additional information: The research has been a collaboration between researchers at Karolinska Institutet, Uppsala University, Aarhus University, Denmark, Norway's University of Science and Technology (NTNU), Norway, the Institute for Health and Welfare (THL), Finland and Fudan University, China.

Source/Credit: Karolinska Institutet | Felicia Lindberg

Reference Number: med042423_03

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