Atrial flutter/fibrillation in adult congenital heart disease: Insights from a large Asian cohort

• Published in: Journal of the Formosan Medical Association Vol. 124; no. 2; pp. 126 - 132
• Main Authors: Chiu, Shuenn-Nan, Tseng, Wei-Chieh, Lu, Chun-Wei, Lin, Ming-Tai, Chen, Chun-An, Wang, Jou-Kou, Wu, Mei-Hwan
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.02.2025; Elsevier
• Subjects: Adult; Adult congenital heart disease; Aged; Atrial fibrillation; Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Atrial Flutter - epidemiology; Atrial Flutter - etiology; Cohort Studies; Congenital heart disease severity; Female; Heart Defects, Congenital - complications; Heart Defects, Congenital - epidemiology; Humans; Hypertension, Pulmonary - epidemiology; Incidence; Major adverse cardiovascular events; Male; Middle Aged; Pulmonary hypertension; Retrospective Studies; Risk Factors; Taiwan - epidemiology; Young Adult; Taiwan; Major adverse cardiovascular events; Congenital heart disease severity; Adult congenital heart disease; Atrial fibrillation; Pulmonary hypertension
• ISSN: 0929-6646
• DOI: 10.1016/j.jfma.2024.07.023

The incidence of atrial fibrillation/atrial flutter (AF/AFL) in general population is lower in Asia compared to Western countries. It is unclear whether a similar trend exists among adults with congenital heart disease (ACHD). We determine the profile, risk factors, and impact of AF/AFL in an Asian ACHD cohort. We included all ACHD patients diagnosed in an Asia tertiary care center between 2007 and 2018, analyzing AF (sustained and paroxysmal AF) and AFL, collectively./Purpose. The study encompassed 4391 patients (55.9% women), with 81% having simple, 16.3% moderate and 2.8% severe CHD. AF/AFL was observed in 6.7% of the patients, with 54.6% having paroxysmal AF, 27.3% sustained AF, and 18.1% AFL. Incidence of AF/AFL increased with age and was higher in patients with pulmonary hypertension (PH), severe CHD, and metabolic syndrome. We found a progressive trend in the onset age of arrhythmia: AFL at a younger age, followed by paroxysmal and sustained AF. Risk factors for AF/AFL included severe and moderate CHD, PH, previous interventions, and male sex (odds ratio 11.2 and 3.15, 2.03, 1.75, and 1.71, respectively). When stratifying by CHD severity, PH and male sex were significant risk factors in simple CHD, while only PH in severe CHD. Patients with AF/AFL had a significantly lower major adverse cardiovascular events-free survival rate. This large ACHD cohort from Asia exhibited a high incidence of AF/AFL, similar to Western reports. The risk of AF/AFL was primarily associated with hemodynamic factors such as PH and CHD severity.