Download development of atrial fibrillation in patients with

DEVELOPMENT OF ATRIAL FIBRILLATION IN PATIENTS WITH
CONGENITAL HEART DEFECTS
Tanwier T.T.K. Ramdjan (Erasmus University Medical Center, Rotterdam, the Netherlands);
Christophe Teuwen (Erasmus University Medical Center, Rotterdam, the Netherlands); Ameeta Yaksh
(Erasmus University Medical Center, Rotterdam, the Netherlands); Luca. J. Jansz (Erasmus University
Medical Center, Rotterdam, the Netherlands); Dominic A. Theuns (Erasmus University Medical Center,
Rotterdam, the Netherlands); Sander G. Molhoek (Amphia Hospital, Breda, the Netherlands); H.G.
Reinhart Dorman (Medisch Spectrum Twente, Enschede, the Netherlands); Jurren M. van Opstal
(Medisch Spectrum Twente, Enschede, the Netherlands); Thelma C. Konings (VU University Medical
Center, Amsterdam, the Netherlands); Joris W.J. Vriend (Haga Teaching Hospital, The Hague, the
Netherlands); Marco Götte (Haga Teaching Hospital, The Hague, the Netherlands); Pepijn van der
Voort (Catharina Hospital, Eindhoven, the Netherlands); Alexandra Riedijk (Erasmus University
Medical Center, Rotterdam, the Netherlands); Paul Knops (Erasmus University Medical Center,
Rotterdam, the Netherlands); Etienne Delacrétaz (Inselspital, University of Bern, Switzerland);
Maarten Witsenburg (Erasmus University Medical Center, Rotterdam, the Netherlands); Jolien W.
Roos-Hesselink (Erasmus University Medical Center, Rotterdam, the Netherlands); Ad J.J.C. Bogers
(Erasmus University Medical Center, Rotterdam, the Netherlands); Natasja M.S. de Groot (Erasmus
University Medical Center, Rotterdam, the Netherlands)
Purpose: Regular atrial tachyarrhythmias (AT) frequently occur in young adults with congenital heart
defects (CHD) whereas atrial fibrillation (AF) is common in the older adult CHD patient. Data on
development of AF in CHD patients is scarce, but is essential as AF is associated with severe
complications. The aim of this multicenter study was to examine development of AF in a large cohort of
patients with a variety of CHD by relating patient with arrhythmia characteristics.
Method: CHD patients (N=184) with documented AF episodes were studied. Patients with prior cardiac
surgery (N=146) were divided into those with pre- (N=14) or post-operative AF episodes (N=132).
Summary: Patients with post-operative AF were significantly younger (42±14 years) compared to
patients without a history of cardiac surgery (63±14 years, p<0.001). Regular AT preceded AF by 4±4
years in 44 (24%) patients and occurred more frequently in patients with a history of cardiac surgery
compared to unrepaired CHDs (28% vs. 8%). Age of first AF presentation did not differ between ‘de
novo’ and “AT to AF” patients (p=0.63). Deterioration to permanent AF was observed in 32 patients
(28%) after 3±4 years and was associated with a lower ventricular response (91±20 bpm) compared to
patients with paroxysms of AF (106±30 bpm, p=0.005).
Conclusion: In CHD patients, AF develops at a relative younger age. The fast progression from regular
AT to AF and from paroxysmal to chronic AF (on average < 4 yr) justifies close follow up and early,
aggressive therapy of both AT and AF.