Key result
Congenital heart defects were associated with atrial fibrillation onset at a mean age of 49 years, coexistence with regular atrial tachycardia in 33% of cases, and progression to persistent AF in 26%.
Why the study?
What is the time course and progression of atrial fibrillation in patients with congenital heart defects?
Cohort (n=199)
Yes
What is the time course and progression of atrial fibrillation in patients with congenital heart defects?
Patients with congenital heart defects develop atrial fibrillation at a relatively young age and experience rapid progression from paroxysmal to persistent/permanent forms, highlighting the need for early and aggressive management.
Answers are grounded in this paper and cite their sources.
May warrant enhanced AF surveillance in congenital heart disease; leaves open optimal intervention timing pending prospective trials.
BACKGROUND: The incidence of atrial fibrillation (AF) is rising in the aging patients with congenital heart defects (CHD). However, studies reporting on AF in patients with CHD are scarce. The aim of this multicenter study was to examine in a large cohort of patients with a variety of CHD: (1) the age of onset and initial treatment of AF, coexistence of atrial tachyarrhythmia and (2) progression of paroxysmal to (long-standing) persistent/permanent AF during long-term follow-up. METHODS AND RESULTS: Patients (n=199) with 15 different CHD and documented AF episodes were studied. AF developed at 49±17 years. Regular atrial tachycardia (AT) coexisting with AF occurred in 65 (33%) patients; 65% initially presented with regular AT. At the end of a follow-up period of 5 (0-24) years, the ECG showed AF in 81 patients (41%). In a subgroup of 114 patients, deterioration from paroxysm of AF to (long-standing) persistent/permanent AF was observed in 29 patients (26%) after only 3 (0-18) years of the first AF episode. Cerebrovascular accidents/transient ischemic attacks occurred in 26 patients (13%), although a substantial number (n=16) occurred before the first documented AF episode. CONCLUSIONS: Age at development of AF in patients with CHD is relatively young compared with the patients without CHD. Coexistence of episodes of AF and regular AT occurred in a considerable number of patients; most of them initially presented with regular AT. The fast and frequent progression from paroxysmal to (long-standing) persistent or permanent AF episodes justifies close follow-up and early, aggressive therapy of both AT and AF.
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Teuwen et al. (2015) conducted a cohort in Congenital heart defects and atrial fibrillation (n=199). Congenital heart defects was evaluated on Age of onset of AF, coexistence of atrial tachyarrhythmia, and progression to persistent/permanent AF. Congenital heart defects were associated with atrial fibrillation onset at a mean age of 49 years, coexistence with regular atrial tachycardia in 33% of cases, and progression to persistent AF in 26%.
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