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 & 2 others Ali Zaidi, Paul Khairy

    Research output: Research - peer-reviewArticle

    • 4 Citations

    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.

    LanguageEnglish (US)
    Pages857-865
    Number of pages9
    JournalJournal of the American College of Cardiology
    Volume70
    Issue number7
    DOIs
    StatePublished - Aug 15 2017

    Fingerprint

    Atrial Fibrillation
    Cardiac Arrhythmias
    Heart Diseases
    Tachycardia
    Odds Ratio
    Confidence Intervals
    Population
    Age Factors
    Multicenter Studies
    Cohort Studies
    Hypertension

    Keywords

    • cohort studies
    • congenital heart defects
    • electrocardiography
    • intra-atrial re-entrant tachycardia
    • tachycardia

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease. / Labombarda, Fabien; Hamilton, Robert; Shohoudi, Azadeh; Aboulhosn, Jamil; Broberg, Craig S.; Chaix, Marie A.; Cohen, Scott; Cook, Stephen; Dore, Annie; Fernandes, Susan M.; Fournier, Anne; Kay, Joseph; Macle, Laurent; Mondésert, Blandine; Mongeon, François Pierre; Opotowsky, Alexander R.; Proietti, Anna; Rivard, Lena; Ting, Jennifer; Thibault, Bernard; Zaidi, Ali; Khairy, Paul.

    In: Journal of the American College of Cardiology, Vol. 70, No. 7, 15.08.2017, p. 857-865.

    Research output: Research - peer-reviewArticle

    Labombarda, F, Hamilton, R, Shohoudi, A, Aboulhosn, J, Broberg, CS, Chaix, MA, Cohen, S, Cook, S, Dore, A, Fernandes, SM, Fournier, A, Kay, J, Macle, L, Mondésert, B, Mongeon, FP, Opotowsky, AR, Proietti, A, Rivard, L, Ting, J, Thibault, B, Zaidi, A & Khairy, P 2017, 'Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease' Journal of the American College of Cardiology, vol 70, no. 7, pp. 857-865. DOI: 10.1016/j.jacc.2017.06.034
    Labombarda, Fabien ; Hamilton, Robert ; Shohoudi, Azadeh ; Aboulhosn, Jamil ; Broberg, Craig S. ; Chaix, Marie A. ; Cohen, Scott ; Cook, Stephen ; Dore, Annie ; Fernandes, Susan M. ; Fournier, Anne ; Kay, Joseph ; Macle, Laurent ; Mondésert, Blandine ; Mongeon, François Pierre ; Opotowsky, Alexander R. ; Proietti, Anna ; Rivard, Lena ; Ting, Jennifer ; Thibault, Bernard ; Zaidi, Ali ; Khairy, Paul. / Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease. In: Journal of the American College of Cardiology. 2017 ; Vol. 70, No. 7. pp. 857-865
    @article{0c307e93142149889e778a22969d8b62,
    title = "Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease",
    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",
    author = "Fabien Labombarda and Robert Hamilton and Azadeh Shohoudi and Jamil Aboulhosn and Broberg, {Craig S.} and Chaix, {Marie A.} and Scott Cohen and Stephen Cook and Annie Dore and Fernandes, {Susan M.} and Anne Fournier and Joseph Kay and Laurent Macle and Blandine Mondésert and Mongeon, {François Pierre} and Opotowsky, {Alexander R.} and Anna Proietti and Lena Rivard and Jennifer Ting and Bernard Thibault and Ali Zaidi and Paul Khairy",
    year = "2017",
    month = "8",
    doi = "10.1016/j.jacc.2017.06.034",
    volume = "70",
    pages = "857--865",
    journal = "Journal of the American College of Cardiology",
    issn = "0735-1097",
    publisher = "Elsevier USA",
    number = "7",

    }

    TY - JOUR

    T1 - Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease

    AU - Labombarda,Fabien

    AU - Hamilton,Robert

    AU - Shohoudi,Azadeh

    AU - Aboulhosn,Jamil

    AU - Broberg,Craig S.

    AU - Chaix,Marie A.

    AU - Cohen,Scott

    AU - Cook,Stephen

    AU - Dore,Annie

    AU - Fernandes,Susan M.

    AU - Fournier,Anne

    AU - Kay,Joseph

    AU - Macle,Laurent

    AU - Mondésert,Blandine

    AU - Mongeon,François Pierre

    AU - Opotowsky,Alexander R.

    AU - Proietti,Anna

    AU - Rivard,Lena

    AU - Ting,Jennifer

    AU - Thibault,Bernard

    AU - Zaidi,Ali

    AU - Khairy,Paul

    PY - 2017/8/15

    Y1 - 2017/8/15

    N2 - 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.

    AB - 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.

    KW - cohort studies

    KW - congenital heart defects

    KW - electrocardiography

    KW - intra-atrial re-entrant tachycardia

    KW - tachycardia

    UR - http://www.scopus.com/inward/record.url?scp=85025830688&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85025830688&partnerID=8YFLogxK

    U2 - 10.1016/j.jacc.2017.06.034

    DO - 10.1016/j.jacc.2017.06.034

    M3 - Article

    VL - 70

    SP - 857

    EP - 865

    JO - Journal of the American College of Cardiology

    T2 - Journal of the American College of Cardiology

    JF - Journal of the American College of Cardiology

    SN - 0735-1097

    IS - 7

    ER -