Clinical Spectrum, independent risk factors, and treatment outcomes of pediatric arrhythmias: a multicenter retrospective analysis in Xinjiang

Background Pediatric arrhythmias are heterogeneous and differ from adult disease in presentation and management; evidence from geographically vast, resource-variable regions of northwestern China remains limited, particularly in settings where access to pediatric electrophysiology services and prolonged rhythm monitoring is uneven. Objective To describe the clinical spectrum of pediatric arrhythmias, identify independent risk factors, and assess treatment effectiveness and safety in a multicenter cohort from Xinjiang. Methods This retrospective multicenter study included children (≤18 years) diagnosed with arrhythmia by ECG and/or 24-hour Holter monitoring in six prefecture-level hospitals in Xinjiang (January 2019 to December 2024). A 1:1 age- and sex-matched healthy cohort served as controls. Candidate factors were screened by univariable chi-square tests and entered into multivariable binary logistic regression; results are reported as ORs with 95% CIs. Management was categorized as regular follow-up, pharmacotherapy, or radiofrequency catheter ablation, with effectiveness assessed using standardized follow-up criteria. Results We enrolled 232 children with arrhythmia (50.9% male), aged 1.2–18.0 years (mean 11.5 ± 3.6); 68.9% were ≥6 years. Supraventricular arrhythmias were most common (49.1%), and PSVT accounted for 35.3%. In multivariable analysis, congenital heart disease (OR 7.265, 95% CI 4.012–13.298), recent infection exposure (OR 6.452, 95% CI 3.605–11.521), and recurrent arrhythmia history (OR 8.216, 95% CI 4.458–15.169) were independent risk factors (all P < 0.05), while age ≥6 years was not. Management included follow-up (65.5%), pharmacotherapy (25.0%), and ablation (9.5%). Ablation in 22 PSVT patients achieved 100% acute success with no recurrence over 6–12 months. Among 102 patients with complete effectiveness evaluation, the overall response rate was 88.2%; four mild adverse drug reactions were observed. Conclusions This Xinjiang multicenter cohort reveals region-specific divergences from published data: higher PSVT (35.3%) and ventricular arrhythmia (24.1%) proportions, and markedly lower ablation utilization (9.5%) vs. tertiary centers in eastern China and internationally. Congenital heart disease, infection exposure, and recurrence history were independent risk factors (ORs 6.5–8.2). Key actionable findings: (1) targeted ECG screening for high-risk children; (2) maintenance of school-based screening for subclinical detection; and (3) effective stratified management with pharmacotherapy and selective ablation, with regional capacity building needed to close the interventional care gap.