In the Journals

Atrial arrhythmias worsen as patients with congenital heart disease age

Atrial fibrillation gains in prevalence and atrial arrhythmias become progressively permanent as patients with congenital heart disease age, according to a study published in the Journal of the American College of Cardiology.

The most common arrhythmia in this population is intra-atrial re-entrant tachycardia, the researchers wrote.

Fabien Labombarda, MD, of the Montreal Heart Institute at the Université de Montreal, and colleagues analyzed data from 482 patients (mean age, 32 years; 45% women) with congenital heart disease and atrial arrhythmias. Patients were categorized as having atrial tachycardia, focal atrial tachycardia or intra-atrial re-entrant tachycardia. Follow-up occurred for a mean of 11.3 years.

Intra-atrial re-entrant tachycardia was seen in 61.6% of the cohort. In addition, 28.8% of patients had AF and 9.5% of patients presented with focal atrial tachycardia.

In multivariable analyses, hypertension (OR = 2; 95% CI, 1.08-3.71) and older age (OR = 1.024 per year; 95% CI, 1.01-1.039) were independently associated with AF.

The occurrence of intra-atrial re-entrant tachycardia increased as the severity of congenital heart disease increased from simple (47.2%), moderate (62.1%) and complex forms (67%; P = .0013). AF was the most common arrhythmia in patients aged 50 years and older (51.2%) compared with younger patients (44.2%; P < .0001).

Throughout follow-up, 62.3% of patients had paroxysmal atrial arrhythmias, 28.2% presented with a persistent form and 9.5% had a permanent clinical pattern.

Permanent arrhythmias increased from 3.1% in patients younger than 20 years to 22.6% in patients aged 50 years and older (P < .0001).

“As patients age, their atrial arrhythmias become increasingly refractory to rhythm-control treatment strategies,” Labombarda and colleagues wrote. “These observations underscore the potential for the arrhythmia burden to escalate and for management issues to become increasingly challenging as atrial fibrillation develops in patients with complex congenital heart disease and arrhythmias become recalcitrant to therapy.”

“There is the potential for AF to develop in any form of [congenital heart disease], simple to complex, with age of the patient as an important factor along with the anatomic/hemodynamic substrate,” Michael J. Silka, MD, professor of pediatrics at the University of Southern California Keck School of Medicine in Los Angeles, and Yaniv Bar-Cohen, MD, associate professor of clinical pediatrics at Children’s Hospital Los Angeles and co-director of Southern California Consortium for Technology and Innovation in Pediatrics in Los Angeles, wrote in a related editorial. “Thus, as the population increases and age of these patients advances, it appears that perhaps the next sequel is slowly being written: a potential AF epidemic in older patients with [congenital heart disease].” – by Darlene Dobkowski

Disclosures: The study was supported by Boehringer Ingelheim. Labombarda reports receiving support from the Fédération Française de Cardiologie. The other authors, Bar-Cohen and Silka report no relevant financial disclosures.

Atrial fibrillation gains in prevalence and atrial arrhythmias become progressively permanent as patients with congenital heart disease age, according to a study published in the Journal of the American College of Cardiology.

The most common arrhythmia in this population is intra-atrial re-entrant tachycardia, the researchers wrote.

Fabien Labombarda, MD, of the Montreal Heart Institute at the Université de Montreal, and colleagues analyzed data from 482 patients (mean age, 32 years; 45% women) with congenital heart disease and atrial arrhythmias. Patients were categorized as having atrial tachycardia, focal atrial tachycardia or intra-atrial re-entrant tachycardia. Follow-up occurred for a mean of 11.3 years.

Intra-atrial re-entrant tachycardia was seen in 61.6% of the cohort. In addition, 28.8% of patients had AF and 9.5% of patients presented with focal atrial tachycardia.

In multivariable analyses, hypertension (OR = 2; 95% CI, 1.08-3.71) and older age (OR = 1.024 per year; 95% CI, 1.01-1.039) were independently associated with AF.

The occurrence of intra-atrial re-entrant tachycardia increased as the severity of congenital heart disease increased from simple (47.2%), moderate (62.1%) and complex forms (67%; P = .0013). AF was the most common arrhythmia in patients aged 50 years and older (51.2%) compared with younger patients (44.2%; P < .0001).

Throughout follow-up, 62.3% of patients had paroxysmal atrial arrhythmias, 28.2% presented with a persistent form and 9.5% had a permanent clinical pattern.

Permanent arrhythmias increased from 3.1% in patients younger than 20 years to 22.6% in patients aged 50 years and older (P < .0001).

“As patients age, their atrial arrhythmias become increasingly refractory to rhythm-control treatment strategies,” Labombarda and colleagues wrote. “These observations underscore the potential for the arrhythmia burden to escalate and for management issues to become increasingly challenging as atrial fibrillation develops in patients with complex congenital heart disease and arrhythmias become recalcitrant to therapy.”

“There is the potential for AF to develop in any form of [congenital heart disease], simple to complex, with age of the patient as an important factor along with the anatomic/hemodynamic substrate,” Michael J. Silka, MD, professor of pediatrics at the University of Southern California Keck School of Medicine in Los Angeles, and Yaniv Bar-Cohen, MD, associate professor of clinical pediatrics at Children’s Hospital Los Angeles and co-director of Southern California Consortium for Technology and Innovation in Pediatrics in Los Angeles, wrote in a related editorial. “Thus, as the population increases and age of these patients advances, it appears that perhaps the next sequel is slowly being written: a potential AF epidemic in older patients with [congenital heart disease].” – by Darlene Dobkowski

Disclosures: The study was supported by Boehringer Ingelheim. Labombarda reports receiving support from the Fédération Française de Cardiologie. The other authors, Bar-Cohen and Silka report no relevant financial disclosures.