Atrial Fibrillation in Congenital Heart Disease

Study Questions:

How do the types and patterns of atrial arrhythmias associated with congenital heart disease (CHD) vary with age?

Methods:

This was a multicenter retrospective cohort study of patients from 12 centers across North America with heterogeneous forms of CHD born before 2003 and documented sustained atrial tachyarrhythmias including atrial fibrillation (AF).

Results:

The study’s important findings were that: 1) intra-atrial reentry tachycardia (IART) is the most common type of atrial arrhythmia in CHD affecting up to 62%, and its prevalence increases as the complexity of CHD increases. 2) AF increases with age and is the most common atrial arrhythmia in CHD patients over 50 years old. 3) The prevalence of permanent arrhythmias increases with age, affecting up to 20% of those over 50 years. A multivariable analysis revealed that older age, hypertension, and history of atrial septal defect independently increases the risk of AF. A history of fewer heart operations decreased the risk of AF.

Conclusions:

The prevalence and pattern of atrial arrhythmias evolves with patient age. IART is the most common arrhythmia overall, but AF and permanent arrhythmias become increasingly problematic in older patients.

Perspective:

Atrial arrhythmias are a well-established, chronic problem in the adult CHD patient. This study further clarifies that problem and adds the unfortunate detail that permanent arrhythmias and AF become more common as these patients age. The growing population of CHD survivors means that atrial arrhythmias will remain a substantial problem that will require the collaborative efforts of adult and pediatric electrophysiology experts to manage.


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