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Atrial arrhythmia is a late complication after tetralogy of Fallot (TOF) repair, but arrhythmia outcomes data are limited. The purpose of the study was to describe atrial arrhythmia presentations, outcomes of antiarrhythmic therapy, and impact of arrhythmia on transplant-free survival.
We reviewed the MACHD (Mayo Adult Congenital Heart Disease) database and identified 113 patients (age 49±13 years) with documented arrhythmia out of 465 TOF patients, 1990-2017. We classified arrhythmias into atrial fibrillation and atrial flutter/tachycardia based on the rhythm on the first abnormal electrocardiogram. The 302 patients without arrhythmia history were used as reference group for survival analysis.
At the time of first documented arrhythmia, 58(51%) had atrial fibrillation while 55(49%) had atrial flutter/tachycardia. Of the 113 patients, 14(12%) received rhythm control with class I/III antiarrhythmic drugs (AAD), 79(70%) had direct current cardioversion, 9(8%) received rate control with class II/IV AAD, and 11(10%) received only anticoagulation. Successful cardioversion occurred in 100(89%) patients; freedom from recurrence was 63% at 60 months. Some patients had >1 arrhythmia type, and the entire cohort was grouped into: atrial flutter/tachycardia (n=25) and atrial fibrillation with or without flutter (n=88). Compared to the reference group, 20-year transplant-free survival was lower in patients with atrial fibrillation (91% vs 64%, p<0.001), but similar in patients with atrial flutter/tachycardia
Atrial fibrillation, but not atrial flutter, was associated with reduced survival in our repaired TOF cohort. Further studies are required to determine if more aggressive antiarrhythmic therapy will improve survival in patients with atrial fibrillation.
Poster Hall, Hall F
Sunday, March 17, 2019, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Heart Disease: Adult 3
Abstract Category: 09. Congenital Heart Disease: Adult
Presentation Number: 1240-479
- 2019 American College of Cardiology Foundation