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Atrial Fibrillation Burden in Young Patients with Congenital Heart Disease.

Journal article
Authors Zacharias Mandalenakis
Annika Rosengren
Georg Lappas
Peter J Eriksson
Thomas Gilljam
Per-Olof Hansson
Kristofer Skoglund
Maria Fedchenko
Mikael Dellborg
Published in Circulation
Volume 137
Issue 9
Pages 928-937
ISSN 1524-4539
Publication year 2018
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 928-937
Language en
Subject categories Cardiovascular medicine


Background -Patients with congenital heart disease (CHD) are assumed to be vulnerable to atrial fibrillation (AF) due to residual shunts, anomalous vessel anatomy, progressive valvulopathy, hypertension, and atrial scars from previous heart surgery. However, the risk of developing AF as well as the complications associated with AF in children and young adults with CHD have not been compared with those in controls. 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 controls 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 controls, 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 controls. According to a hierarchic 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% (70/654) 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 controls. 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.

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