From Minor Monitoring to Major Insight: Predicting AF Development in the Congenital Heart Disease Population

Area of Science:

• Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• Prognostic value of ECG and continuous rhythm monitoring (CRM) markers for atrial fibrillation (AF) in congenital heart disease (CHD) is unclear.
• AF is a common complication in CHD patients, impacting morbidity and mortality.

Purpose of the Study:

• To investigate the predictive value of baseline ECG and CRM parameters for AF onset and progression in CHD patients.
• To identify noninvasive markers for risk stratification in this population.

Main Methods:

• Retrospective analysis of 573 CHD patients with 24-hour Holter monitoring.
• Assessment of baseline ECG and CRM parameters, including atrial ectopy (AE) and ventricular ectopy burdens.
• Cox regression analysis to identify predictors of new-onset AF and AF progression.

Main Results:

• 18.7% of patients developed AF during follow-up; 29.9% of those progressed to persistent AF (PeAF).
• Independent predictors of new-onset AF included older age, left atrial (LA) dilatation, higher AE burden, atrial tachycardia, and pacemaker implantation.
• AF progression was associated with older age, LA dilatation, higher AE burden, and prolonged PR interval; AE burden was a stronger predictor in patients without LA dilatation.

Conclusions:

• Baseline ECG PR-intervals and CRM-derived AE burden are independent predictors of AF onset and/or progression in CHD patients.
• These noninvasive markers can enhance risk stratification and support personalized rhythm management strategies.