Atrial Arrhythmias in Adult Patients With Right- Versus Left-Sided Congenital Heart Disease Anomalies

      Atrial arrhythmias (AAs) are a common complication in adult patients with congenital heart disease. We sought to compare the lifetime prevalence of AAs in patients with right- versus left-sided congenital cardiac lesions and their effect on the prognosis. A congenital heart disease diagnosis was assigned using the International Disease Classification, Ninth Revision, diagnostic codes in the administrative databases of Quebec, from 1983 to 2005. Patients with AAs were those diagnosed with an International Disease Classification, Ninth Revision, code for atrial fibrillation or intra-atrial reentry tachycardia. To ensure that the diagnosis of AA was new, a washout period of 5 years after entry into the database was used, a period during which the patient could not have received an International Disease Classification, Ninth Revision, code for AA. The cumulative lifetime risk of AA was estimated using the Practical Incidence Estimators method. The hazard ratios (HRs) for mortality, morbidity, and cardiac interventions were compared between those with right- and left-sided lesions after adjustment for age, gender, disease severity, and cardiac risk factors. In a population of 71,467 patients, 7,756 adults developed AAs (isolated right-sided, 2,229; isolated left-sided, 1,725). The lifetime risk of developing AAs was significantly greater in patients with right- sided than in patients with left-sided lesions (61.0% vs 55.4%, p <0.001). The HR for mortality and the development of stroke or heart failure was similar in both groups (HR 0.96, 95% confidence interval [CI] 0.86 to 1.09; HR 0.94, 95% CI 0.80 to 1.09; and HR 1.10, 95% CI 0.98 to 1.23, respectively). However, the rates of cardiac catheterization (HR 0.63, 95% CI 0.55 to 0.72), cardiac surgery (HR 0.40, 95% CI 0.36 to 0.45), and arrhythmia surgery (HR 0.77, 95% CI 0.6 to 0.98) were significantly less for patients with right-sided lesions. In conclusion, patients with right-sided lesions had a greater lifetime burden of AAs. However, their morbidity and mortality were no less than those with left-sided lesions, although the rate of intervention was substantially different.
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        • Ravelli F.
        • Allessie M.
        Effects of atrial dilatation on refractory period and vulnerability to atrial fibrillation in the isolated Langendorff-perfused rabbit heart.
        Circulation. 1997; 96: 1686-1695
        • Marelli A.J.
        • Mackie A.S.
        • Ionescu-Ittu R.
        • Rahme E.
        • Pilote L.
        Congenital heart disease in the general population: changing prevalence and age distribution.
        Circulation. 2007; 115: 163-172
        • Mackie A.S.
        • Pilote L.
        • Ionescu-Ittu R.
        • Rahme E.
        • Marelli A.J.
        Health care resource utilization in adults with congenital heart disease.
        Am J Cardiol. 2007; 99: 839-843
        • Echahidi N.
        • Pibarot P.
        • O'Hara G.
        • Mathieu P.
        Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery.
        J Am Coll Cardiol. 2008; 51: 793-801
        • Beiser A.
        • D'Agostino Sr, R.B.
        • Seshadri S.
        • Sullivan L.M.
        • Wolf P.A.
        Computing estimates of incidence, including lifetime risk: Alzheimer's disease in the Framingham Study: the Practical Incidence Estimators (PIE) macro.
        Stat Med. 2000; 19: 1495-1522
        • Vasan R.S.
        • Beiser A.
        • Seshadri S.
        • Larson M.G.
        • Kannel W.B.
        • D'Agostino R.B.
        • Levy D.
        Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham Heart study.
        JAMA. 2002; 287: 1003-1010
        • Heeringa J.
        • van der Kuip D.A.
        • Hofman A.
        • Kors J.A.
        • van Herpen G.
        • Stricker B.H.
        • Stijnen T.
        • Lip G.Y.
        • Witteman J.C.
        Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam Study.
        Eur Heart J. 2006; 27: 949-953
        • Lloyd-Jones D.M.
        • Wang T.J.
        • Leip E.P.
        • Larsson M.G.
        • Levy D.
        • Vasan R.S.
        • D'Agostino R.B.
        • Massaro J.M.
        • Beiser A.
        • Wolf P.A.
        • Benjamin E.J.
        Lifetime risk for development of atrial fibrillation: the Framingham Heart study.
        Circulation. 2004; 10: 1042-1046
        • Oh J.K.
        • Holmes Jr, D.R.
        • Hayes D.L.
        • Porter C.B.
        • Danielson G.K.
        Cardiac arrhythmias in patients with surgical repair of Ebstein's anomaly.
        J Am Coll Cardiol. 1985; 6: 1351-1357
        • Driscoll D.J.
        • Offord K.P.
        • Feldt R.H.
        • Schaff H.V.
        • Puga F.J.
        • Danielson G.K.
        Five to fifteen year follow up after Fontan operation.
        Circulation. 1992; 85: 469-496
        • Bommer W.
        • Neuman A.
        • Neef J.
        • Mason D.T.
        • deMaria A.
        Determination of right atrial and right ventricular size by two-dimensional echocardiography.
        Circulation. 1979; 60: 91-100
        • Shaheen J.
        • Rosemann D.
        • Klutsein M.W.
        • Falkowsky G.
        • Bitran D.
        • Tzivoni D.
        Effect of surgical repair of secundum-type atrial septal defect on right atrial, right ventricular and left ventricular volumes in adults.
        Am J Cardiol. 2000; 86: 1395-1397
        • Attenhofer Jost C.H.
        • Seifert B.
        • Maly F.
        • Fatio R.
        • Turina J.
        • Jenni R.
        Remodeling after surgical repair of atrial septal defects within the oval fossa.
        Cardiol Young. 2002; 12: 506-512
        • Schaff H.V.
        • Deaeani J.A.
        • Daly R.C.
        • Orszulak T.A.
        • Danielson G.K.
        Cox Mmaze procedure for atrial fibrillation: Mayo Clinic experience.
        Semin Thorac Cardiovasc Surg. 2000; 12: 30-37
        • Giamberti A.
        • Chessa M.
        • Foresti S.
        • Abella R.
        • Butera G.
        • de Vincentiis C.
        • Carminati
        • Menicanti L.
        • Frigiola A.
        Combined atrial septal defect surgical closure and irrigated radiofrequency ablation in adult patients.
        Ann ThorThorac Surg. 2006; 82: 1327-1331
        • Jackman W.N.
        • Beckman K.J.
        • McClelland J.H.
        • Wang X.
        • Friday K.J.
        • Roman C.A.
        • Moulton K.P.
        • Twidale N.
        • Hazlitt H.A.
        • Prior M.I.
        Treatment of supraventricular tachycardia due to AV nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction.
        N Engl J Med. 1992; 327: 313-318
        • Fischer B.
        • Haissaguerre M.
        • Guarriges S.
        • Poquet F.
        • Gencel L.
        • Clementy J.
        • Marcus F.I.
        Radiofrequency cathether ablation of common atrial flutter in 80 patients.
        J Am Coll Cardiol. 1995; 25: 1365-1372
        • Haissaguerre M.
        • Jaïs P.
        • Shah D.C.
        • Takahashi A.
        • Hocini M.
        • Quiniou G.
        • Garrrigue S.
        • Le Mouroux A.
        • Le Métayer P.
        • Clémenty J.
        Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.
        N Engl J Med. 1998; 339: 659-666
        • Chen S.A.
        • Hsieh M.H.
        • Tai C.T.
        • Tsai C.F.
        • Prakash V.S.
        • Yu W.C.
        • Hsu T.L.
        • Ding Y.A.
        • Chang M.S.
        Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological responses, and effects of radio frequency ablation.
        Circulation. 1999; 100: 1879-1886
        • Essebag V.
        • Wylie J.V.
        • Josephson M.E.
        Effectiveness of catheter ablation of atrial fibrillation.
        Eur Heart J. 2006; 27: 130-131
        • Fuster V.
        • Rydén L.E.
        • Cannom D.S.
        • Crijns H.J.
        • Curtis A.B.
        • Ellenbogen K.A.
        • Halperin J.L.
        • Le Heuzey J.Y.
        • Kay G.N.
        • Lowe J.E.
        • Olsson S.B.
        • Prystowsky E.N.
        • Tamargo J.L.
        • Wann S.
        • Smith Jr, S.C.
        • Jacobs A.K.
        • Adams C.D.
        • Anderson J.L.
        • Antman E.M.
        • Halperin J.L.
        • Hunt S.A.
        • Nishimura R.
        • Ornato J.P.
        • Page R.L.
        • Riegel B.
        • Priori S.G.
        • Blanc J.J.
        • Budaj A.
        • Camm A.J.
        • Dean V.
        • Deckers J.W.
        • Despres C.
        • Dickstein K.
        • Lekakis J.
        • McGregor K.
        • Metra M.
        • Morais J.
        • Osterspey A.
        • Tamargo J.L.
        • Zamorano J.L.
        ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.
        Europace. 2006; 8: 651-745
        • Tsai C.F.
        • Tai C.T.
        • Hsieh M.H.
        • Lin W.S.
        • Yu W.C.
        • Ueng K.C.
        • Ding Y.A.
        • Chang M.S.
        • Chen S.A.
        Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava: electrophysiological characteristics and results of radio frequency ablation.
        Circulation. 2000; 102: 67-74
        • Mansour M.
        • Ruskin J.
        • Keane D.
        Initiation of atrial fibrillation by ectopic beats originating from the ostium of the inferior vena cava.
        J Cardiovasc Electrophysiol. 2002; 13: 1292-1295
        • Kholova I.
        • Kautzner J.
        Morphology of atrial myocardial extensions into human caval veins: a postmortem study in patients with and without atrial fibrillation.
        Circulation. 2004; 110: 483-488