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Time Course of Atrial Fibrillation in Patients With Congenital Heart Defects

Christophe P Teuwen1, Tanwier T T K Ramdjan1, Marco Götte1

  • 1From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (B.J.J.M.B., T.C.K.); Department of Cardiology, Radboud University Medical Center, Nijmegen; The Netherlands (R.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (S.G.M.); Department of Cardiology; Medisch Spectrum Twente, Enschede, The Netherlands (H.G.R.D., J.M.v.O.); Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands (P.v.d.V.); Cardiology, Inselspital, University of Bern, Bern, Switzerland (E.D.); Department of Cardiology, Boston Children's Hospital, MA (J.K.T.); and Department of Pediatrics, Harvard Medical School, Boston, MA (J.K.T.).

Circulation. Arrhythmia and Electrophysiology
|August 16, 2015
PubMed

Insights

Congenital heart defect patients develop atrial fibrillation (AF) and atrial tachycardia (AT) at a younger age. Early, aggressive treatment is crucial due to rapid progression from paroxysmal to persistent AF.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Congenital Heart Disease

Background:

  • Rising incidence of atrial fibrillation (AF) in aging patients with congenital heart defects (CHD).
  • Limited research on AF prevalence and characteristics in CHD populations.
  • Need for comprehensive data on AF onset, progression, and associated arrhythmias in CHD.

Purpose of the Study:

  • To investigate the age of onset and initial management of AF in a large, diverse CHD cohort.
  • To assess the coexistence and presentation of atrial tachyarrhythmia (AT) with AF.
  • To evaluate the progression of paroxysmal AF to persistent or permanent forms during long-term follow-up.

Main Methods:

  • Multicenter study of 199 patients with 15 different types of CHD and documented AF.
  • Analysis of AF onset age, initial treatment, and coexisting AT.
  • Long-term follow-up to assess AF progression and cerebrovascular events.

Main Results:

  • AF onset occurred at a mean age of 49±17 years.
  • Atrial tachycardia (AT) coexisted with AF in 33% of patients, with 65% initially presenting with AT.
  • AF progressed from paroxysmal to persistent/permanent forms in 26% of patients within 3 years.
  • Cerebrovascular accidents/transient ischemic attacks occurred in 13% of patients.

Conclusions:

  • AF develops at a relatively young age in CHD patients compared to the general population.
  • A significant proportion of CHD patients experience both AF and AT, often with AT presenting first.
  • The rapid progression necessitates vigilant monitoring and prompt, assertive treatment for both AT and AF in this population.
Abstract

Keywords:
atrial fibrillationcongenital heart defectstroketachycardiathoracic surgery

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