Recurrent sustained atrial arrhythmias and thromboembolism in Fontan patients with total cavopulmonary connection
| Autor: | Fred Rodriguez, Alexander C. Egbe, Heidi M. Connolly, Janaki Devara, Ari M. Cedars, Ahmed Goda Sakr, William R. Miranda, Jeremy P. Moore, Momina Iftikhar, Salil Ginde, Matthew Russell, Jasmine Grewal, Likhita Shaik, Adam M. Lubert, Anitha S. John |
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| Rok vydání: | 2021 |
| Předmět: |
Tachycardia
medicine.medical_specialty Population Fontan operation Thromboembolic complication 030204 cardiovascular system & hematology Lower risk 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Diseases of the circulatory (Cardiovascular) system Cumulative incidence cardiovascular diseases 030212 general & internal medicine Risk factor education First episode Original Paper education.field_of_study AAD anti-arrhythmic drug therapy business.industry Atrial fibrillation Atrial arrhythmia medicine.disease Total cavopulmonary connection RC666-701 cardiovascular system Cardiology TCPC total cavopulmonary connection medicine.symptom Cardiology and Cardiovascular Medicine business Atrial flutter |
| Zdroj: | International Journal of Cardiology. Heart & Vasculature International Journal of Cardiology: Heart & Vasculature, Vol 33, Iss, Pp 100754-(2021) |
| ISSN: | 2352-9067 |
| DOI: | 10.1016/j.ijcha.2021.100754 |
| Popis: | Background Total cavopulmonary connection (TCPC) is associated with a lower risk of incident atrial arrhythmias as compared to atriopulmonary Fontan, but the risk of recurrent atrial arrhythmias is unknown in this population. The purpose of this study was to determine the incidence and risk factors for recurrent atrial arrhythmias and thromboembolic complications in patients with TCPC. Methods This is a retrospective multicenter study conducted by the Alliance for Adult Research in Congenital Cardiology (AARCC), 2000–2018. The inclusion criteria were TCPC patients (age > 15 years) with prior history of atrial arrhythmia. Results A total of 103 patients (age 26 ± 7 years; male 58 [56%]) met inclusion criteria. The mean age at initial arrhythmia diagnosis was 13 ± 5 years, and atrial arrhythmias were classified as atrial flutter/tachycardia in 85 (83%) and atrial fibrillation in 18 (17%). The median duration of follow-up from the first episode of atrial arrhythmia was 14.9 (12.1–17.3) years, and during this period 64 (62%) patients had recurrent atrial arrhythmias (atrial flutter/tachycardia 51 [80%] and atrial fibrillation 13 [20%]) with annual incidence of 4.4%. Older age was a risk factor for arrhythmia recurrence while the use of a class III anti-arrhythmic drug was associated with a lower risk of recurrent arrhythmias. The incidence of thromboembolic complication was 0.6% per year, and the cumulative incidence was 4% and 7% at 5 and 10 years respectively from the time of first atrial arrhythmia diagnosis. There were no identifiable risk factors for thromboembolic complications in this cohort. Conclusions Although TCPC provides superior flow dynamics and lower risk of incident atrial arrhythmias, there is a significant risk of recurrent arrhythmias among TCPC patients with a prior history of atrial arrhythmias. These patients may require more intensive arrhythmia surveillance as compared to other TCPC patients. |
| Databáze: | OpenAIRE |
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