Atrial Arrhythmias in Adults With Congenital Heart Disease

Abstract

Background-Atrial arrhythmias increase disease burden in the general adult population. Adults with congenital heart lesions constitute a rapidly growing group of patients with cardiovascular disease. We hypothesized that atrial arrhythmias increase with age and impair health outcomes in this population. Methods and Results-We conducted a population-based analysis of prevalence, lifetime risk, mortality, and morbidity associated with atrial arrhythmias in adults with congenital heart disease from l983 to 2005. In 38 428 adults with congenital heart disease in 2005, 5812 had atrial arrhythmias. Overall, the 20-year risk of developing atrial arrhythmia was 7% in a 20-year-old subject and 38% in a 50-year-old subject. More than 50% of patients with severe congenital heart disease reaching age 18 years developed atrial arrhythmias by age 65 years. In patients with congenital heart disease, the hazard ratio of any adverse event in those with atrial arrhythmias compared with those without was 2.50 (95% confidence interval, 2.38 to 2.62; PϽ0.0001), with a near 50% increase in mortality (hazard ratio, 1.47; 95% confidence interval, 1.37 to 1.58; PϽ0.001), more than double the risk of morbidity (stroke or heart failure) (hazard ratio, 2.21; 95% confidence interval, 2.07 to 2.36; PϽ0.001), and 3 times the risk of cardiac interventions (hazard ratio, 3.00; 95% confidence interval, 2.81 to 3.20; PϽ0.001). Conclusions-Atrial arrhythmias occurred in 15% of adults with congenital heart disease. The lifetime incidence increased steadily with age and was associated with a doubling of the risk of adverse events. An increase in resource allocation should be anticipated to deal with this increasing burden.

The right ventricle in patients with chronic heart failure and atrial fibrillation

“…Risk factors for AF or other atrial arrhythmia development included age, CHF and right atrial size. The results of the studies showed that atrial arrhythmias are associated with 2.5 fold increased risk of morbidity and 50% increased risk of mortality [45,46].…”

Prophylactic arrhythmia surgery in association with congenital heart disease

“…The marked improvement in survival among patients with congenital heart disease has been associated with the recognition that late arrhythmias and heart failure account for over half of late deaths (29,30). Among adults with congenital heart disease, the development of atrial arrhythmias is associated with a 50% increase in early mortality, a two-fold increase in stroke and congestive heart failure, and a three-fold increase in the need for cardiac interventions (31). Lesions associated with the highest prevalence of supraventricular tachycardia (SVT) include Ebstein anomaly, atrial repairs of transposition of the great arteries, univentricular hearts, ASDs, and right heart obstructive lesions such as TOF and double outlet right ventricle (31).…”

“…Among adults with congenital heart disease, the development of atrial arrhythmias is associated with a 50% increase in early mortality, a two-fold increase in stroke and congestive heart failure, and a three-fold increase in the need for cardiac interventions (31). Lesions associated with the highest prevalence of supraventricular tachycardia (SVT) include Ebstein anomaly, atrial repairs of transposition of the great arteries, univentricular hearts, ASDs, and right heart obstructive lesions such as TOF and double outlet right ventricle (31). Of these defects, more than 25% of patients with right heart obstructive lesions, Ebstein anomaly, and univentricular hearts undergo reoperations (10,32).…”

Atrial Fibrillation in Children

“…Congenital heart defects may be associated with atrial arrhythmias either before or after surgical correction (Attenhofer Jost et al, 2005;Berger et al, 2005;Bouchardy et al, 2009;Chatzis et al, 2008;Chauvaud et al 2001;Collins, 2009;Hallioglu et al, 2004;Hayashi et al, 2006;Kammeraad et al, 2004;Kaseno et al, 2008;Khairy et al, 2010;Khositeth et al, 2004;Luciani et al, 2008;Marelli et al;Massin et al, 2010;Porter & Garson, 1993;Radford & Izukawa, 1977;Saul, 2008;Spies et al, 2008;Sugimoto et al, 2001, Trojnarska et al, 2009. Those congenital heart defects occurring in conjunction with atrial fibrillation include those associated with abnormalities in the development of the cardiac conduction system, abnormalities in the development of atrial structure, abnormalities in flow resulting in atrial enlargement, abnormalities in impulse initiation or conduction from surgical atrial scarring.…”