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
N1 - Publisher Copyright:
© 2017 American College of Cardiology Foundation
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
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U2 - 10.1016/j.jacc.2017.06.034
DO - 10.1016/j.jacc.2017.06.034
M3 - Article
C2 - 28797355
AN - SCOPUS:85025830688
SN - 0735-1097
VL - 70
SP - 857
EP - 865
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 7
ER -