Patients with congenital heart disease are up to 85 times more likely to suffer from atrial fibrillation as adults. The researchers behind a study are now advocating more frequent screenings of the most vulnerable groups.
"We need to identify those who have the most increased risk of complications. Today they are young adults and we are not sure what will happen once they get into their 50's or 60's," says Zacharias Mandalenakis, cardiology researcher at Sahlgrenska Academy, Sweden, and cardiology consultant at Sahlgrenska University Hospital.
By cross-checking data from the patient register, the cause of death register and the total population register, the researchers have managed to identify 21,982 people with congenital heart disease, born in 1970-1993. Also included in the study are 219,816 gender, age and county matched control subjects.
They are all born during a period of great advancements in healthcare with early diagnoses and efforts, heart operations on new-borns, repeat surgeries as needed and so on. A patient group under the microscope but with unanswered questions regarding the future.
"They survive and cope rather well but unfortunately they develop other heart problems, such as atrial fibrillation and heart failure. It is a challenge for us to discover it early and take preventative actions," says Mandalenakis.
The group with the most complex congenital heart disease proved to have the highest relative risk of atrial fibrillation; 85 times higher than the control subjects. One out of twelve in this group developed atrial fibrillation and out of those subjects one in ten developed heart failure.
Once all the severity degrees of congenital heart disease were added together the risk of atrial fibrillation was 22 times higher than in the control subjects. In patients with congenital heart disease and atrial fibrillation, the risk of heart failure was eleven times higher than in those with congenital heart disease but without atrial fibrillation.
Four out of ten people with congenital heart disease had undergone at least one operation. The group of operated subjects had an almost fourfold increased risk of developing atrial fibrillation compared to those with congenital heart disease who had not undergone surgery. The risk was the highest for subjects with an atrial septal defect (ASD), regarded by many as a minor heart defect.
"We have previously used clinical practice as a reference but with this study we have discovered sub-groups that we need to pay special attention to, and perhaps administer anticoagulation or antiarrhythmic treatment to prevent them from being affected by heart failure, stroke or premature death," says Mandalenakis.
As someone who is clinically active at the university hospital's so called GUCH unit, with national care in the area of congenital heart disease, he can attest to the preparedness that many patients themselves have.
"They try to exercise a lot and stay healthy in other respects, and we keep in very good contact with our patients. As soon as something happens, that they experience breathlessness or heart palpitations, they seek help immediately," he explains.
Abstract
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.
Authors
Zacharias Mandalenakis, Annika Rosengren, Georg Lappas, Peter Eriksson, Thomas Gilljam, Per-Olof Hansson, Kristofer Skoglund, Maria Fedchenko, Mikael Dellborg
[link url="http://www.gu.se/english/about_the_university/news-calendar/News_detail//increased-risk-of-atrial-fibrillation-with-congenital-heart-disease.cid1533130"]University of Gothenburg material[/link]
[link url="http://circ.ahajournals.org/content/early/2017/10/31/CIRCULATIONAHA.117.029590"]Circulation abstract[/link]