Incidence, Risk Factors, and Outcomes of Atrial Arrhythmias in Adult Patients With Atrioventricular Septal Defect.

Autor:	Jacquemart E; Electrophysiology Section, European Georges Pompidou Hospital, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Université de Paris, Inserm, Paris Cardiovascular Research Centre, Paris, France., Bessière F; Louis Pradel Hospital, Lyon, France., Combes N; Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France; Pasteur Clinic, Toulouse, France., Ladouceur M; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Université de Paris, Inserm, Paris Cardiovascular Research Centre, Paris, France., Iserin L; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France., Gardey K; Louis Pradel Hospital, Lyon, France., Henaine R; Louis Pradel Hospital, Lyon, France., Dulac A; Louis Pradel Hospital, Lyon, France., Cohen S; Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France., Belli E; Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France., Jannot AS; Department of Medical Informatics and Public Health, European Georges Pompidou Hospital, Paris, France., Chevalier P; Louis Pradel Hospital, Lyon, France., Ly R; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France., Clavier S; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France., Legendre A; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France., Petit J; Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France., Maltret A; Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France., Di Filippo S; Louis Pradel Hospital, Lyon, France., Hascoët S; Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France., Marijon E; Electrophysiology Section, European Georges Pompidou Hospital, Paris, France; Université de Paris, Inserm, Paris Cardiovascular Research Centre, Paris, France., Waldmann V; Electrophysiology Section, European Georges Pompidou Hospital, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Université de Paris, Inserm, Paris Cardiovascular Research Centre, Paris, France. Electronic address: victor.waldmann@gmail.com.
Jazyk:	angličtina
Zdroj:	JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2022 Mar; Vol. 8 (3), pp. 331-340. Date of Electronic Publication: 2021 Oct 27.
DOI:	10.1016/j.jacep.2021.09.004
Abstrakt:	Objectives: This study aimed to assess the incidence, associated factors, and outcomes of atrial arrhythmias in adults with atrioventricular septal defect (AVSD). Background: Data regarding atrial arrhythmias in adults with AVSD are particularly scarce. Methods: Data were analyzed from a multicentric cohort of adult patients with AVSD. Lifetime cumulative incidences of atrial arrhythmias were studied. Multiple logistic regression models were used to identify risk factors. Results: A total of 391 patients (61.6% women) were enrolled with a mean age of 36.3 ± 16.3 years and a mean follow-up of 17.3 ± 14.2 years after initial surgical repair. Overall, 98 patients (25.1%) developed at least 1 episode of atrial arrhythmia at a mean age of 39.2 ± 17.2 years. The mean ages of patients at first episode of intra-atrial re-entrant tachycardia (IART)/ focal atrial tachycardia (FAT) and atrial fibrillation were 33.7 ± 15.3 and 44.3 ± 16.5 years, respectively. The lifetime risks for developing atrial arrhythmia to ages 20, 40, and 60 years were 3.7%, 17.8%, and 55.3%, respectively. IART/FAT was the leading arrhythmia until the age of 45, then atrial fibrillation surpassed IART/FAT. Age (odds ratio [OR]: 1.4; 95% confidence interval [CI]: 1.2-1.6), number of cardiac surgeries (OR: 4.1; 95% CI: 2.5-6.9), left atrial dilatation (OR: 3.1; 95% CI: 1.4-6.8), right atrial dilatation (OR: 4.1; 95% CI: 1.7-10.3), and moderate or severe left atrioventricular valve regurgitation (OR: 3.7; 95% CI: 1.2-11.7) were independently associated with a higher risk of atrial arrhythmias, whereas the type of AVSD and the age at repair were not. The occurrence of atrial arrhythmias was associated with pacemaker implantation (41.8% vs. 8.5%; P < 0.001), heart failure (24.5% vs. 1.0%; P < 0.001), and cerebrovascular accidents (11.2% vs. 3.4%; P = 0.007). Conclusions: The lifetime risk of atrial arrhythmias in patients with AVSD is considerable with more than half of patients developing ≥1 atrial arrhythmia by the age of 60 and is associated with a significant morbidity. The risk in partial/intermediate AVSD is as high as in complete AVSD and is not impacted by age at repair. Competing Interests: Funding Support and Author Disclosures The authors have received a research grant from the French Institute of Health and Medical Research and the Fédération Française de Cardiologie. (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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