November 1, 2017Open Access
View Full PaperAtrial Fibrillation Burden in Young Patients With Congenital Heart Disease
Key Result
Congenital heart disease in children and young adults was associated with a 22-fold higher risk of developing atrial fibrillation compared to matched controls (HR 21.99; 95% CI 19.26-25.12).
Study Design
Type
Cohort (n=241,798)
Multicenter
Yes
Structured PICO
Does congenital heart disease increase the risk of developing atrial fibrillation in children and young adults compared to matched controls?
P
Population
241,798 individuals, comprising 21,982 patients with congenital heart disease born between 1970 and 1993 and 219,816 matched controls, followed for a mean of 27 years.
E
Exposure
Diagnosis of congenital heart disease (CHD) (exposure)
C
Comparator
219,816 control subjects from the Total Population Register in Sweden, matched by birth year, sex, and county (1:10 matching).
O
Outcome
Development of atrial fibrillation (AF)hard clinical
Children and young adults with congenital heart disease have a 22-fold higher risk of developing atrial fibrillation compared to matched controls, with the highest risk seen in those with complex defects.
Main Result
Hazard Ratio: 21.99 (95% CI 19.26–25.12)
Absolute Event Rate: 2.98% vs 0.15%
Abstract
BACKGROUND: Patients with congenital heart disease (CHD) are assumed to be vulnerable to atrial fibrillation (AF) as a result of residual shunts, anomalous vessel anatomy, progressive valvulopathy, hypertension, and atrial scars from previous heart surgery. However, the risk of developing AF and the complications associated with AF in children and young adults with CHD have not been compared with those in control subjects. METHODS: Data from the Swedish Patient and Cause of Death registers were used to identify all patients with a diagnosis of CHD who were born from 1970 to 1993. Each patient with CHD was matched by birth year, sex, and county with 10 control subjects from the Total Population Register in Sweden. Follow-up data were collected until 2011. RESULTS: Among 21 982 patients (51.6% men) with CHD and 219 816 matched control subjects, 654 and 328 developed AF, respectively. The mean follow-up was 27 years. The risk of developing AF was 21.99 times higher (95% confidence interval, 19.26-25.12) in patients with CHD than control subjects. According to a hierarchical CHD classification, patients with conotruncal defects had the highest risk (hazard ratio, 84.27; 95% confidence interval, 56.86-124.89). At the age of 42 years, 8.3% of all patients with CHD had a recorded diagnosis of AF. Heart failure was the quantitatively most important complication in patients with CHD and AF, with a 10.7% (70 of 654) recorded diagnosis of heart failure. CONCLUSIONS: The risk of AF in children and young adults with CHD was 22 times higher than that in matched control subjects. Up to the age of 42 years, 1 of 12 patients with CHD had developed AF, and 1 of 10 patients with CHD with AF had developed heart failure. The patient groups with the most complex congenital defects carried the greatest risk of AF and could be considered for targeted monitoring.