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Atrial Fibrillation and HF Hospitalization in Tetralogy of Fallot
Study Questions:
What is the impact of atrial fibrillation on heart failure (HF) hospitalization and the potential role of atrial fibrillation therapy on the incidence of HF hospitalization and mortality in the adult tetralogy of Fallot (TOF) population?
Methods:
The investigators queried the MACHD (Mayo Adult Congenital Heart Disease) database for adults with repaired TOF and documented atrial fibrillation from 1990 to 2017. The primary endpoint was HF hospitalization, defined as admission for volume overload (pulmonary congestion and/or peripheral edema) requiring intravenous diuretics. The secondary endpoint was the effect of rhythm control therapy on HF hospitalization and all-cause mortality. Patients were divided into rhythm control and rate control groups based on the therapy initiated at the time of arrhythmia diagnosis. Incremental Cox proportional hazards models were used to assess the relationship between atrial fibrillation and HF hospitalization.
Results:
Of 415 patients, 27 (7%) had 42 HF hospitalizations. Of these 415 patients, 88 (21%) had atrial fibrillation at age 49 ± 13 years. Atrial fibrillation was an independent risk factor for HF hospitalization (adjusted hazard ratio, 2.67; 95% confidence interval, 1.04-7.34; p = 0.045). The 88 patients were divided into the rhythm control group (n = 61, 69%) and the rate control group (n = 27, 31%). The rate control group had higher unadjusted annual incidence of HF hospitalization (13% vs. 3%; p = 0.001) and all-cause mortality (11% vs. 4%; p = 0.002).
Conclusions:
The authors concluded that atrial fibrillation was a risk factor for HF hospitalization and mortality in TOF patients, and rhythm control therapy was protective against these adverse events.
Perspective:
This study reports that among TOF patients, the prevalence of HF hospitalization was four-fold higher among the patients with atrial fibrillation compared with the rest of the cohort. Furthermore, HF hospitalization was associated with all-cause mortality. Of note, rhythm control therapy had a protective effect against HF hospitalization and mortality, as evidenced by a lower incidence of HF hospitalization and all-cause mortality. Given limitations of the current analysis, additional studies are indicated to assess the optimal therapy for patients with new-onset atrial fibrillation and the role of proactive cardiovascular disease risk factor modification on the incidence and outcomes of atrial fibrillation in patients with TOF.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Diuretics, Edema, Heart Defects, Congenital, Heart Failure, Hospitalization, Primary Prevention, Risk Factors, Tetralogy of Fallot
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