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Circ Arrhythm Electrophysiol. 2015 Oct;8(5):1065-72. doi: 10.1161/CIRCEP.115.003272. Epub 2015 Aug 14.

Time Course of Atrial Fibrillation in Patients With Congenital Heart Defects.

Author information

1
From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (B.J.J.M.B., T.C.K.); Department of Cardiology, Radboud University Medical Center, Nijmegen; The Netherlands (R.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (S.G.M.); Department of Cardiology; Medisch Spectrum Twente, Enschede, The Netherlands (H.G.R.D., J.M.v.O.); Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands (P.v.d.V.); Cardiology, Inselspital, University of Bern, Bern, Switzerland (E.D.); Department of Cardiology, Boston Children's Hospital, MA (J.K.T.); and Department of Pediatrics, Harvard Medical School, Boston, MA (J.K.T.).
2
From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (B.J.J.M.B., T.C.K.); Department of Cardiology, Radboud University Medical Center, Nijmegen; The Netherlands (R.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (S.G.M.); Department of Cardiology; Medisch Spectrum Twente, Enschede, The Netherlands (H.G.R.D., J.M.v.O.); Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands (P.v.d.V.); Cardiology, Inselspital, University of Bern, Bern, Switzerland (E.D.); Department of Cardiology, Boston Children's Hospital, MA (J.K.T.); and Department of Pediatrics, Harvard Medical School, Boston, MA (J.K.T.). n.m.s.degroot@erasmusmc.nl.

Abstract

BACKGROUND:

The incidence of atrial fibrillation (AF) is rising in the aging patients with congenital heart defects (CHD). However, studies reporting on AF in patients with CHD are scarce. The aim of this multicenter study was to examine in a large cohort of patients with a variety of CHD: (1) the age of onset and initial treatment of AF, coexistence of atrial tachyarrhythmia and (2) progression of paroxysmal to (long-standing) persistent/permanent AF during long-term follow-up.

METHODS AND RESULTS:

Patients (n=199) with 15 different CHD and documented AF episodes were studied. AF developed at 49±17 years. Regular atrial tachycardia (AT) coexisting with AF occurred in 65 (33%) patients; 65% initially presented with regular AT. At the end of a follow-up period of 5 (0-24) years, the ECG showed AF in 81 patients (41%). In a subgroup of 114 patients, deterioration from paroxysm of AF to (long-standing) persistent/permanent AF was observed in 29 patients (26%) after only 3 (0-18) years of the first AF episode. Cerebrovascular accidents/transient ischemic attacks occurred in 26 patients (13%), although a substantial number (n=16) occurred before the first documented AF episode.

CONCLUSIONS:

Age at development of AF in patients with CHD is relatively young compared with the patients without CHD. Coexistence of episodes of AF and regular AT occurred in a considerable number of patients; most of them initially presented with regular AT. The fast and frequent progression from paroxysmal to (long-standing) persistent or permanent AF episodes justifies close follow-up and early, aggressive therapy of both AT and AF.

KEYWORDS:

atrial fibrillation; congenital heart defect; stroke; tachycardia; thoracic surgery

PMID:
26276884
DOI:
10.1161/CIRCEP.115.003272
[Indexed for MEDLINE]

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