What is the clinical evidence from this study?

Study design: Cohort. Population: Congenital heart disease (n=573). Intervention: Baseline ECG PR-intervals and atrial ectopy burden vs. Patients without these markers. Primary outcome: New-onset atrial fibrillation and atrial fibrillation progression.

June 27, 2026Journal of Cardiovascular Development and Disease0 citationsOpen Access

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

CZCan ZhangErasmus MC LDLixia DaiErasmus MC ABAnnemien E. van den BoschAdult Congenital Heart Disease

Key Result

Baseline ECG PR-intervals and atrial ectopy burden independently predicted atrial fibrillation onset, which occurred in 18.7% of patients over 13 years, and progression.

Key Points

The study aims to identify predictors of atrial fibrillation onset and progression in patients with congenital heart disease using ECG and CRM data.
Retrospective analysis of 573 congenital heart disease patients
Assessment of baseline ECG and continuous rhythm monitoring parameters
Cox regression to identify predictors of new-onset atrial fibrillation and progression
Atrial fibrillation occurred in 107 patients (18.7%) over 13 ± 5 years, with 32 (29.9%) progressing to persistent/permanent AF.
Independent predictors of new-onset AF included older age, left atrial dilatation, higher atrial ectopy burden, atrial tachycardia, and pacemaker implantation.
AF progression was linked to older age, left atrial dilatation, higher atrial ectopy burden, and prolonged PR interval.

Study Design

Type

Cohort (n=573)

Structured PICO

Do baseline ECG and CRM-derived markers predict atrial fibrillation onset and progression in patients with congenital heart disease?

Population

573 patients with congenital heart disease who underwent 24-hour Holter monitoring, followed for a mean of 13 years.

Exposure

Baseline electrocardiography (ECG) and continuous rhythm monitoring (CRM) parameters

Outcome

New-onset atrial fibrillation (AF) and AF progression to persistent/permanent AFhard clinical

Baseline ECG PR-intervals and CRM-derived atrial ectopy burden independently predict AF onset and progression in patients with congenital heart disease, potentially improving risk stratification.

Abstract

Background: The prognostic value of electrocardiography (ECG)- and continuous rhythm monitoring (CRM)-derived markers for predicting atrial fibrillation (AF) onset and progression remains unclear in patients with congenital heart disease (CHD). Methods: We retrospectively analyzed 573 CHD patients who underwent 24 h Holter monitoring between 2003 and 2015. Baseline ECG and CRM parameters were assessed. Cox regression identified predictors of new-onset AF and AF progression, and interaction analyses explored effect modification by left atrial (LA) dilatation. Results: During 13 ± 5 years of follow-up, AF occurred in 107 patients (18.7%), of whom 32 (29.9%) progressed to persistent/permanent AF (PeAF). Patients with AF more frequently had prolonged PR and QTc intervals and higher atrial ectopy (AE) and ventricular ectopy burdens. Independent predictors of new-onset AF were older age, LA dilatation, higher AE burden, atrial tachycardia, and pacemaker implantation. AF progression was independently associated with older age, LA dilatation, higher AE burden, and prolonged PR interval. AE burden showed a stronger association with AF risk in patients without LA dilatation. Conclusions: In CHD patients, baseline ECG PR-intervals and CRM-derived AE burden independently predict AF onset and/or progression. These noninvasive markers may improve risk stratification and support earlier personalized rhythm management.

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