Frequent atrial extrasystolic beats predict atrial fibrillation in patients with congenital heart defects

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Congenital heart defects (n=573). Intervention: Frequent atrial extrasystolic beats (AES) vs. Lower frequency of atrial extrasystolic beats. Primary outcome: De novo development of atrial fibrillation (HR 1.95, 95% CI 1.21-3.13, p=0.016).

Christophe P. Teuwen; Tim I.M. Korevaar; Rosa L. Coolen; Twan van der Wel; Charlotte A. Houck; Reinder Evertz; Ameeta Yaksh; Jolien W. Roos‐Hesselink; Ad J.J.C. Bogers; Natasja M.S. de Groot

doi:10.1093/europace/euw300

October 4, 2016EP EuropaceOpen Access

Frequent atrial extrasystolic beats predict atrial fibrillation in patients with congenital heart defects

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Key result

A one-point increase in the natural logarithm of total daily atrial extrasystolic beats was associated with a nearly two-fold higher risk of developing de novo atrial fibrillation (HR 1.95).

Why the study?

Does a higher frequency of atrial extrasystolic beats predict the development of atrial fibrillation in adult patients with congenital heart defects?

Study Design

Type

Cohort (n=573)

Multicenter

Yes

Structured PICO

Does a higher frequency of atrial extrasystolic beats predict the development of atrial fibrillation in adult patients with congenital heart defects?

P

Population

573 adult patients with congenital heart defects who underwent 24-hour Holter monitoring, followed for a median of 51.6 months to assess the development of atrial fibrillation.

E

Exposure

Higher frequency of atrial extrasystolic (AES) beats on 24h Holter monitoring

C

Comparator

Lower frequency of atrial extrasystolic (AES) beats

O

Outcome

Development of de novo atrial fibrillation (AF)hard clinical

Main Result

Hazard Ratio: 1.95 (95% CI 1.21–3.13)

p-value: p=0.016

Frequent atrial extrasystolic beats are common in relatively young adults with congenital heart defects and independently predict the development of de novo atrial fibrillation.

Limitations

Retrospective design increasing the risk of information bias
Study performed in patients with various CHD types, which may affect generalizability
Low prevalence of known risk factors of AF such as hypertension and diabetes limited their assessment
Heart failure diagnosis could not be accurately assessed due to the retrospective design
Small number of patients who developed AF
Asymptomatic AF episodes might have been missed, potentially underestimating the true incidence
Confounding by indication due to the obligatory presence of a Holter registration
Episodes of undiagnosed or asymptomatic AF might have been missed
A longer follow-up period could reveal more patients with AF

Implication

May identify higher AF risk in congenital heart disease; leaves open whether suppression alters outcomes.

Abstract

Aims: Atrial fibrillation (AF) is increasingly observed in patients with congenital heart defects (CHDs) who survive nowadays into adulthood. Yet, predictors of AF are scarce in this high-risk population. This study therefore examined the predictive ability of atrial extrasystole (AES) for development of AF in CHD patients. Methods and results: Adult CHD patients who had a 24 h Holter registration were followed to determine who developed AF. A total of 573 patients (49% male, mean age 35 ± 12 years) were included; they had a simple/complete repaired CHD (n = 279), complex repaired CHD (n = 251), or univentricular heart (UVH, n = 43). Ageing (P < 0.0001), female gender (P = 0.028), UVH (P = 0.0010), and left atrial dilatation (P = 0.0025) were associated with the number of AES. During a median follow-up of 51.6 months (interquartile range 22.8-85.7), 29 patients (5%) developed de novo AF. An one-point increase in the number of logtotal-AES was associated with a two-fold higher risk of AF development (hazard ratio 1.95; 95% confidence interval 1.21-3.13; P = 0.016). C-statistic for left atrial dilatation, complexity, and age had a good discriminative ability for the incidence of AF with a C-statistic of 84.5%. The addition of the total number of AES/24 h to this model increased C-statistic to 88.4%. Conclusion: Atrial extrasystole occur relatively frequent in adult CHD patients compared with patients with other cardiac diseases. This is the first study that showed an association between an increased AES frequency and a higher risk of AF development in CHD patients.

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Cite This Study

Teuwen et al. (2016) conducted a cohort in Congenital heart defects (n=573). Frequent atrial extrasystolic beats (AES) vs. Lower frequency of atrial extrasystolic beats was evaluated on De novo development of atrial fibrillation (HR 1.95, 95% CI 1.21-3.13, p=0.016). A one-point increase in the natural logarithm of total daily atrial extrasystolic beats was associated with a nearly two-fold higher risk of developing de novo atrial fibrillation (HR 1.95).

synapsesocial.com/papers/6a973bd2d002c28d9989d560 https://doi.org/10.1093/europace/euw300