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J Am Coll Cardiol. 2017 Aug 15;70(7):857-865. doi: 10.1016/j.jacc.2017.06.034.

Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease.

Author information

1
Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
2
The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
3
Montreal Health Innovations Coordinating Center (MHICC), Montreal, Quebec, Canada.
4
Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, Los Angeles, California.
5
Oregon Health and Science University, Portland, Oregon.
6
The Wisconsin Adult Congenital Heart (WAtCH) Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
7
Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
8
Departments of Pediatrics and Medicine, Stanford University, Palo Alto, California.
9
CHU mère-enfant Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
10
University of Colorado Denver, Aurora, Colorado.
11
Boston Adult Congenital Heart Service, Boston Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
12
Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania.
13
Nationwide Children's Hospital, Ohio State University, Columbus, Ohio.
14
Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Montreal Health Innovations Coordinating Center (MHICC), Montreal, Quebec, Canada. Electronic address: paul.khairy@umontreal.ca.

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

PMID:
28797355
DOI:
10.1016/j.jacc.2017.06.034
[Indexed for MEDLINE]
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