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Isolated atrial fibrillation is an infrequent arrhythmia in the pediatric population, especially in the absence of organic heart disease of a probably multifactorial etiology. Both of the cases we present here corresponded to a first episode of AF that was haemodynamically insignificant in patients with no known history of heart disease. Persistent left superior vena cava, diagnosed in case 1, has been associated with the development of supraventricular arrhythmias, including AF. Radiofrequency catheter ablation of these connections can prevent their recurrence. Hsu et al. described 5 cases of AF where electrophysiology testing identified persistent left superior vena cava as the source arrhythmia. To our knowledge, an association between AF and bicuspid aortic valve, a defect detected in case 2, has not been previously reported, and therefore the coexistence of these 2 disorders could be coincidental and unrelated to the disease process. Intense physical activity may cause electrical and structural changes in the atria that would promote the development of an episode of AF. In both our patients, AF was associated with physical activity. There is also evidence of an association between chest trauma with commotio cordis and AF. Cases of isolated familial AF have been reported in the literature in association with genetic mutations affecting multiple ion channels and circulating hormones such as atrial natriuretic peptide. However, the diagnostic yield of genetic testing for this type of arrhythmia is currently not known. In this regard, the presence of idiopathic AF in the father of case 1 may have increased the risk of AF in our patient. In addition, consumption of some recreational substances, such as cannabis, can trigger AF. In the cases presented here, we ruled out the consumption of arrhythmogenic substance use. In a series of 1750 cases of isolated AF in children, the only risk factors identified were obesity with a BMI above the 95th percentile, male sex and age greater than 14 years. At present there is no consensus regarding the first-line antiarrhythmic drug for treatment of AF in the pediatric age group. However, drugs used to control heart rate (such as beta blockers) are the most widely used agents. In the 2 cases presented here, treatment with flecainide was chosen with the aim of achieving cardioversion. In cases refractory to pharmacotherapy, electrical cardioversion and radiofrequency ablation of the sources of atrial arrhythmia are effective alternatives. Lastly, the use of anticoagulant therapy was ruled out in both cases due to the low risk of thrombosis and the early recovery of the sinus rhythm. In any case, there are no guidelines providing the indication of prophylactic treatment for prevention of stroke in this population.

Malformación linfática mesentérica: una causa poco frecuente de abdomen agudo