Predictors of atrial tachyarrhythmias in adults with congenital heart disease

Abstract

Background: Atrial tachyarrhythmias (ATs) represent the major late complications of congenital heart diseases (CHDs) following surgery. Little is known about the association between echocardiographic parameters and AT.

Aims: This study aimed to investigate a potential correlation among clinical, echocardiographic, and electrocardiographic parameters and AT as well as to analyze outcomes in adults with CHD and AT.

Methods: A retrospective case‑control study was performed in adults with CHD. We included 71 patients with AT and 71 control individuals matched by sex, age, and the type of CHD without AT, all from the same institute. Medical records, electrocardiograms, and echocardiograms were reviewed. Adverse cardiovascular events were recorded and defined as cardiovascular mortality, admission for heart failure, or stroke. The univariate and multivariate logistic regression analysis of possible risk factors and the Kaplan–Meier analysis of adverse cardiovascular events were performed.

Results: Subpulmonary ventricular systolic pressure≥40 mm Hg (hazard ratio [HR], 6.8; 95% CI, 2.4–18; P < 0.001), right atrial dilatation≥21 cm2 (HR, 3.1; 95% CI, 1.2–7.6; P = 0.01), and significant tricuspid regurgitation (HR, 4; 95% CI, 1.3–10; P = 0.02) were identified as the main risk factors for AT. Patients with AT had worse outcomes, more frequently developed adverse cardiovascular events (86% vs 14%; P < 0.01), and exhibited a 58% event‑free survival rate compared with 98% of the patients without AT after 8 years of follow‑up (log rank, 6.6; P = 0.01).

Conclusions: Among patients with CHD, the main risk factors for AT include right atrial dilatation, high subpulmonary ventricular systolic pressure, and significant tricuspid regurgitation. The presence of AT may increase the risk of adverse cardiac events.