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 ThibaultAli Zaidi, Paul Khairy

    Research output: Contribution to journalArticle

    32 Scopus 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.

    Original languageEnglish (US)
    Pages (from-to)857-865
    Number of pages9
    JournalJournal of the American College of Cardiology
    Volume70
    Issue number7
    DOIs
    StatePublished - Aug 15 2017

    Keywords

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

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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    Labombarda, F., Hamilton, R., Shohoudi, A., Aboulhosn, J., Broberg, C. S., Chaix, M. A., Cohen, S., Cook, S., Dore, A., Fernandes, S. M., Fournier, A., Kay, J., Macle, L., Mondésert, B., Mongeon, F. P., Opotowsky, A. R., Proietti, A., Rivard, L., Ting, J., ... Khairy, P. (2017). Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease. Journal of the American College of Cardiology, 70(7), 857-865. https://doi.org/10.1016/j.jacc.2017.06.034