AF common in Marfan syndrome, leads to worse long-term outcomes
PHILADELPHIA — Atrial fibrillation is common in patients with Marfan syndrome and may lead to worse survival, researchers reported at the American Heart Association Scientific Sessions.
Despite increased risk for worse long-term outcomes, use of antiarrhythmic therapy did not offer a significant mortality benefit, according to the results.
“Marfan syndrome patients now almost have normal life expectancy because of advances in recognition of the disease, treatment and better outcomes with surgery,” Vidyasagar Kalahasti, MD, director of the Marfan Syndrome and Connective Tissue Disorder Clinic in the Aortic Center and staff cardiologist in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic, told Healio. “As these patients are living longer, they are developing the same problems that we see with other patients with regard to atrial fibrillation or heart failure.”
Apas Aggarwal, MD, a medical resident at the Cleveland Clinic, Kalahasti and colleagues analyzed data from 977 patients (mean age, 34 years, 35.3% women) with Marfan syndrome who presented to the hospital from 1983 to 2016. The researchers reviewed electronic medical records for AF diagnoses, patient characteristics and last follow-up date or death.
Overall, 15.6% of patients with Marfan syndrome had a history of AF. Of those, 22.4% died during the mean follow-up of 6.4 years, compared with 8.8% of patients without AF (P < .001).
Seventy percent of patients with Marfan syndrome and a history of AF reported antiarrhythmic therapy use. Survival was not significantly different in patients who received antiarrhythmic therapy compared with those who did not (P = .326), according to the results.
Only 10 patients with Marfan syndrome and AF were referred for catheter ablation.
“A lot of work still needs to be done as to why atrial fibrillation occurs in patients with Marfan syndrome,” Kalahasti said in an interview. “They are still in the younger cohort compared to average patients, in whom we see AF happening in the 70s and 80s, and this cohort is much younger than that. Trying to understand, is it something unique about them? I suspect so because I think they likely have association with mitral valve prolapse and mitral regurgitation, which can play a bigger role in atrial remodeling and leading to atrial fibrillation.” – by Darlene Dobkowski
Aggarwal A, et al. Atrial Fibrillation – Monitoring and Special Risk Groups. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Disclosures: Aggarwal and Kalahasti report no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.