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Predictive model for late atrial arrhythmia after closure of an atrial septal defect
Alexander Van De Bruaene1, Philip Moons, An Belmans
1University Hospitals Leuven, Belgium.
Insights
A new risk score predicts late atrial arrhythmia after atrial septal defect (ASD) repair. Key factors include pulmonary hypertension and prior arrhythmia, aiding clinical risk stratification for better patient outcomes.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Cardiac Arrhythmia
Background:
- Atrial septal defect (ASD) management relies on risk factors predicting late atrial arrhythmia.
- Identifying these risk factors is crucial for clinical decision-making.
Purpose of the Study:
- To develop a quantitative model for predicting event-free survival from late atrial arrhythmia post-ASD repair.
- To establish a risk score for assessing individual patient risk.
Main Methods:
- Analysis of data from the Belgian Congenital Heart Disease Registry for ASD type secundum patients.
- Inclusion of age at repair, gender, pulmonary hypertension, and pre/post-repair arrhythmia in a Cox-regression model.
- Validation of the derived weighted risk score using the Brier score.
Main Results:
- 155 patients with 349 follow-up years were analyzed; 25.2% developed late atrial arrhythmia.
- Significant predictors included elevated mean pulmonary arterial pressure (mPAP ≥ 25 mmHg), pre-existing atrial arrhythmia, arrhythmia within one month post-repair, and gender.
- A validated risk score (0-28 points) was developed to predict arrhythmia-free survival up to 5 years, with a mean Brier score of 0.10.
Conclusions:
- A well-validated risk model for predicting arrhythmia-free survival in ASD repair patients has been developed.
- Further research is required to assess its utility in individual clinical risk stratification and applicability to other congenital heart defects.
Objectives:
To develop a quantitative event-free prediction model of late atrial arrhythmia after atrial septal defect (ASD) repair.
Background:
The clinical management of ASD is driven by risk factors that determine the occurrence of late atrial arrhythmia.
Methods:
Data from ASD type secundum patients, included in the Belgian Congenital Heart Disease Registry, were analyzed. Based on review of the literature, age at repair, gender, pulmonary hypertension, atrial arrhythmia before and within one month after repair were included in the model. Using Cox-regression analysis, a weighted risk score was derived, which was validated using the Brier score.
Results:
A total of 155 patients (117 women; median age at follow-up 53.9 years, range 18.0-78.8) having 349 follow-up years was included. Thirty-nine patients (25.2%) presented with late atrial arrhythmia. Multivariate analysis showed that a mPAP ≥ 25 mmHg (HR 4.39; 95%CI 2.17-9.09; P<0.0001), the presence of atrial arrhythmia before (HR 3.52; 95%CI 1.75-7.14; P=0.002) and ≤ 1month after repair (HR 6.62; 95%CI 2.38-20.00; P<0.0001) and gender (HR 2.18 95%CI 1.11-4.35) were associated with late atrial arrhythmia. A risk score (0 to 28 points) to predict atrial arrhythmia free survival was derived for follow-up times ranging from one to 5 years. Mean Brier score for the model was 0.10.
Conclusions:
We formulated a well validated risk model to predict arrhythmia-free survival in ASD patients undergoing ASD repair. Further research is needed whether this model can be used for individual clinical risk stratification and whether the model can be adapted for application in other congenital heart defects.
