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

Can Zhang1, Lixia Dai1,2, Annemien E van den Bosch1

  • 1Department of Cardiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands.

Journal of Cardiovascular Development and Disease
|July 27, 2026
PubMed

Insights

In congenital heart disease (CHD) patients, electrocardiography (ECG) PR-intervals and continuous rhythm monitoring (CRM)-derived atrial ectopy (AE) burden predict atrial fibrillation (AF) onset and progression, aiding risk stratification.

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 identify electrocardiography (ECG) and continuous rhythm monitoring (CRM) derived markers predicting AF onset and progression in CHD patients.
  • To explore the role of left atrial (LA) dilatation in modifying these associations.

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 and interaction analyses to identify predictors of new-onset AF and AF progression.

Main Results:

  • 18.7% of patients developed AF during follow-up; 29.9% progressed to persistent/permanent AF (PeAF).
  • Independent predictors of new-onset AF included older age, 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.
  • These noninvasive markers can enhance risk stratification for personalized rhythm management in CHD patients.
Abstract

Keywords:
Holter monitoringPR intervalQTc intervalatrial fibrillationcongenital heart diseaseectopic beatselectrocardiography

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