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

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

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.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Age Factors
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology*
  • Atrial Fibrillation / etiology
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Heart Conduction System / physiopathology
  • Heart Defects, Congenital / complications*
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / physiopathology
  • Humans
  • Male
  • Prevalence
  • Quebec / epidemiology
  • Retrospective Studies
  • Risk Assessment / methods*
  • Tachycardia, Supraventricular / diagnosis
  • Tachycardia, Supraventricular / epidemiology*
  • Tachycardia, Supraventricular / etiology
  • Young Adult