Atrial Fibrillation Therapy and Heart Failure Hospitalization in Adults With Tetralogy of Fallot

Egbe, Alexander C.; Miranda, William R.; Ammash, Naser M.; Ananthaneni, Sindhura; Sandhyavenu, Harigopal; Abdelsamid, Mohamed Farouk; Yogeswaran, Vidhushei; Kapa, Suraj; Fatola, Ayotola; Kothapalli, Srikanth; Connolly, Heidi M.

doi:10.1016/j.jacep.2019.01.005

Cited by 24 publications

(13 citation statements)

References 26 publications

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“…[1][2][3][4]7,8 There are many risk factors associated with HF, and interventions that reduce the burden of HF have been shown to improve survival in some CHD diagnoses. [11][12][13][14][15] Although advanced HF (stage D HF) is a likely outcome for some adults with CHD, especially the patients with severe or complex CHD, there are limited data about this disease entity. 8,16,17 The current study provides an estimate of the risk of developing advanced HF, and the risk factors associated with newonset advanced HF such as CHD severity and complexity.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Advanced Heart Failure in Adults With Congenital Heart Disease

Egbe

Miranda

Jain

et al. 2022

Circ: Heart Failure

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Background: There are limited data about the stage D heart failure (advanced HF) in adults with congenital heart disease. Our study objectives were (1) to determine the incidence of new-onset advanced HF in patients and the relationship between advanced HF and all-cause mortality and (2) to determine the relationship between therapies for advanced HF and all-cause mortality. Methods: Retrospective cohort study of adults with congenital heart disease at Mayo Clinic (2003–2019). We defined advanced HF using the European Society of Cardiology diagnostic criteria for advanced HF. Therapies received by the patients with advanced HF were classified into 3 mutually exclusive groups (treatment pathways): (1) conventional cardiac intervention, (2) transplant listing, and (3) palliative care. Results: Of 5309 patients without advanced HF at baseline assessment, 432 (8%) developed advanced HF during follow-up (1.1%/y), and the incidence of advanced HF was higher in patients with severe or complex congenital heart disease. Onset of advanced HF was associated with 6-fold increase in the risk of mortality. Conventional cardiac intervention was associated with significantly higher risk of mortality as compared to transplant listing. The longer the interval from the initial onset of advanced HF to transplant evaluation, the lower the odds of being listed for transplant. Conclusions: Based on these data, we postulate that early identification of patients with advanced HF, and a timely referral for transplant evaluation (instead of conventional cardiac intervention) may offer the best chance of survival for these critically ill patients. Further studies are required to validate this postulation.

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Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Advanced Heart Failure in Adults With Congenital Heart Disease

Egbe

Miranda

Jain

et al. 2022

Circ: Heart Failure

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“…AF ablation can be performed safely in patients with CHD, but the probability of durable success is lower in patients with anatomically complex disease. 6,22–24 Multiple AA mechanisms may coexist in the same patient and typically involve a combination of the cavotricuspid isthmus, scar-based macroreentrant tachycardia, or a focal atrial tachycardia, thereby requiring complex ablations. 11,17,18,25…”

Section: Atrial Tachyarrhythmias and Sinus Node Dysfunctionmentioning

confidence: 99%

“…9,11,13 AF is common in hospitalized patients with TOF 14 and is associated with a 4-fold increase in heart failure–related admissions. 6…”

Section: Atrial Tachyarrhythmias and Sinus Node Dysfunctionmentioning

confidence: 99%

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Arrhythmias in Repaired Tetralogy of Fallot: A Scientific Statement From the American Heart Association

Krieger¹,

Zeppenfeld²,

DeWitt³

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Arrhythmia and sudden cardiac death remain common in repaired tetralogy of Fallot and affect even those with excellent anatomic repairs. Atrial arrhythmia often has mechanisms different from those in acquired heart disease. Ventricular arrhythmia remains a major source of mortality in repaired tetralogy of Fallot. Noninvasive risk stratification is important to identify patients who may benefit from ablation or primary prevention implantable cardioverter defibrillators. Multiple noninvasive risk factors are associated with ventricular arrhythmia, but no universally accepted risk stratification algorithm exists. The mechanism of ventricular arrhythmia is usually attributable to a consistent and discrete set of slowly conducting anatomic isthmuses related to both the native anatomy and the consequences of the surgical repair, which interact with ventricular remodeling to provide arrhythmic substrate. This substrate can be identified during electroanatomic mapping and prophylactically ablated in appropriate patients. This scientific statement discusses the mechanisms and treatment of arrhythmia in repaired tetralogy of Fallot.

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“…Although there have been no randomized studies of the comparative efficacy of rate control vs rhythm control therapies for atrial fibrillation in the TOF population, a recent observational study showed a reduction in mortality and heart failure hospitalizations in patients who received rhythm control therapy. 27…”

Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

Prognostic Implications of Left Ventricular Cardiomyopathy in Adults With Tetralogy of Fallot

et al. 2020

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Background: Despite the significant risk of cardiovascular mortality after tetralogy of Fallot (TOF) repair, there are limited data about left ventricular (LV) cardiomyopathy in this population, thus creating important knowledge gaps. This study aims to address some of these knowledge gaps by describing the risk and prognostic implications of LV systolic dysfunction (LVD) after TOF repair. Methods: We performed a cohort study of adult patients after TOF repair with an echocardiographic assessment of LV ejection fraction (LVEF) to determine the association between LVD and cardiovascular events, defined as sustained ventricular tachycardia, aborted sudden death, heart transplantation, or death. Prevalent and incidence LVD were defined as LVEF < 50% at baseline or new decrease in LVEF to < 50% during follow-up, respectively.

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Atrial Fibrillation Therapy and Heart Failure Hospitalization in Adults With Tetralogy of Fallot

Cited by 24 publications

References 26 publications

Incidence and Outcomes of Advanced Heart Failure in Adults With Congenital Heart Disease

Incidence and Outcomes of Advanced Heart Failure in Adults With Congenital Heart Disease

Arrhythmias in Repaired Tetralogy of Fallot: A Scientific Statement From the American Heart Association

Prognostic Implications of Left Ventricular Cardiomyopathy in Adults With Tetralogy of Fallot

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