Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease
Fabien Labombarda, Robert Hamilton, Azadeh Shohoudi, Jamil Aboulhosn, Craig S Broberg, Marie A Chaix, Scott Cohen, Stephen Cook, Annie Dore, Susan M Fernandes, Anne Fournier, Joseph Kay, Laurent Macle, Blandine Mondésert, François-Pierre Mongeon, Alexander R Opotowsky, Anna Proietti, Lena Rivard, Jennifer Ting, Bernard Thibault, Ali Zaidi, Paul Khairy, AARCC, Fabien Labombarda, Robert Hamilton, Azadeh Shohoudi, Jamil Aboulhosn, Craig S Broberg, Marie A Chaix, Scott Cohen, Stephen Cook, Annie Dore, Susan M Fernandes, Anne Fournier, Joseph Kay, Laurent Macle, Blandine Mondésert, François-Pierre Mongeon, Alexander R Opotowsky, Anna Proietti, Lena Rivard, Jennifer Ting, Bernard Thibault, Ali Zaidi, Paul Khairy, AARCC
Abstract
Background: Atrial arrhythmias are the most common complication encountered in the growing and aging population with congenital heart disease.
Objectives: This study sought to assess the types and patterns of atrial arrhythmias, associated factors, and age-related trends.
Methods: A multicenter cohort study enrolled 482 patients with congenital heart disease and atrial arrhythmias, age 32.0 ± 18.0 years, 45.2% female, from 12 North American centers. Qualifying arrhythmias were classified by a blinded adjudicating committee.
Results: The most common presenting arrhythmia was intra-atrial re-entrant tachycardia (IART) (61.6%), followed by atrial fibrillation (28.8%), and focal atrial tachycardia (9.5%). The proportion of arrhythmias due to IART increased with congenital heart disease complexity from 47.2% to 62.1% to 67.0% in patients with simple, moderate, and complex defects, respectively (p = 0.0013). Atrial fibrillation increased with age to surpass IART as the most common arrhythmia in those ≥50 years of age (51.2% vs. 44.2%; p < 0.0001). Older age (odds ratio [OR]: 1.024 per year; 95% confidence interval [CI]: 1.010 to 1.039; p = 0.001) and hypertension (OR: 2.00; 95% CI: 1.08 to 3.71; p = 0.029) were independently associated with atrial fibrillation. During a mean follow-up of 11.3 ± 9.4 years, the predominant arrhythmia pattern was paroxysmal in 62.3%, persistent in 28.2%, and permanent in 9.5%. Permanent atrial arrhythmias increased with age from 3.1% to 22.6% in patients <20 years to ≥50 years, respectively (p < 0.0001).
Conclusions: IART is the most common presenting atrial arrhythmia in patients with congenital heart disease, with a predominantly paroxysmal pattern. However, atrial fibrillation increases in prevalence and atrial arrhythmias progressively become permanent as the population ages.
Keywords: cohort studies; congenital heart defects; electrocardiography; intra-atrial re-entrant tachycardia; tachycardia.
Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed