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Impact of atrial arrhythmia on survival in adults with tetralogy of Fallot
- Source :
- American Heart Journal. 218:1-7
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Background Atrial arrhythmia is a late complication after tetralogy of Fallot (TOF) repair, but arrhythmia outcomes data are limited. Objectives The purpose of the study was to describe atrial arrhythmia presentations, outcomes of antiarrhythmic therapy, and impact of arrhythmia on transplant-free survival. Methods We reviewed the MACHD (Mayo Adult Congenital Heart Disease) Registry and identified 113 patients (age 49 ± 13 years) with documented arrhythmia, and 302 patients without history of arrhythmia, 1990-2017. We classified arrhythmias into atrial fibrillation and atrial flutter/tachycardia based on the rhythm on the first abnormal electrocardiogram. Results At the time of first documented arrhythmia, 58(51%) had atrial fibrillation while 55(49%) had atrial flutter/tachycardia. Of the 113 patients, 14(12%) received rhythm control with class I/III antiarrhythmic drugs (AAD), 79(70%) had direct current cardioversion, 9(8%) received rate control with class II/IV AAD, and 11(10%) received only anticoagulation. Successful cardioversion occurred in 100(89%) patients, and arrhythmia recurrence rate was 16 per 100 patient-years. The multivariate risk factors for death and/or heart transplant were atrial fibrillation (HR 1.94, CI 1.10-3.15, P = .031) and older age (HR 1.63, CI 1.12-2.43, P = .019) per 5 year increment. Conclusions Atrial fibrillation, but not atrial flutter, was associated with reduced survival in our repaired TOF cohort. Further studies are required to determine if more aggressive antiarrhythmic therapy will improve survival in patients with atrial fibrillation.
- Subjects :
- Adult
Male
Tachycardia
medicine.medical_specialty
Heart disease
medicine.medical_treatment
Electric Countershock
030204 cardiovascular system & hematology
Cardioversion
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Recurrence
Risk Factors
Internal medicine
Atrial Fibrillation
medicine
Humans
Registries
cardiovascular diseases
030212 general & internal medicine
Retrospective Studies
Tetralogy of Fallot
business.industry
Age Factors
Retrospective cohort study
Atrial fibrillation
Middle Aged
medicine.disease
Treatment Outcome
Atrial Flutter
Cohort
Catheter Ablation
cardiovascular system
Cardiology
Heart Transplantation
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Anti-Arrhythmia Agents
Atrial flutter
Subjects
Details
- ISSN :
- 00028703
- Volume :
- 218
- Database :
- OpenAIRE
- Journal :
- American Heart Journal
- Accession number :
- edsair.doi.dedup.....cfcf7baded395f5db415a221ca630af2