Mortality in adults with congenital heart disease and atrial arrhythmias

22 Pages·2010·1.61 MB·English

Mortality in Adults with Congenital
Heart Disease and Atrial Arrhythmias:
Identification of the High-Risk Patient
Yap SC, Harris L, Oechslin EN, Chauhan VS, Silversides CK
Toronto General Hospital, Toronto, Canada
Conflicts of Interests
• Dr. Yap: none
• Dr. Harris: none
• Dr. Oechslin: none
• Dr. Chauhan: none
• Dr. Silversides: none
Background
• Atrial arrhythmias in adults with congenital
heart disease are common (~15%) and are
associated with an increased mortality risk
• Does every ACHD patient with atrial
arrhythmias have a poor survival?
Verheugt et al. Eur. Heart J 2010;31:1220-9
Bouchardy et al. Circulation 2009;120:1679-86
Increased predisposition to atrial
arrhythmias in CHD patients
Atrial
myopathy
Increased
Surgical
wall
scars
stress
Lifetime risk of developing AA
in ACHD patients
The cumulative incidence is 50%
by age 65 years
N = 38,428
Bouchardy et al. Circulation 2009;120:1679-86
Atrial arrhythmias are associated
with a higher risk of mortality
47% increase in mortality
compared to those without
atrial arrhythmias
N = 38,428
Bouchardy et al. Circulation 2009;120:1679-86
Aims and Methods
• Aims: determine the incidence and predictors
of mortality in the ACHD population with atrial
arrhythmias
• Design: retrospective, single-center study
• Study patients: ACHD patients (≥18 years)
with a clinical presentation of documented
AF/IART
• Study period: 1999 - 2009
Classification of mode of death
• Death occurring <1 hour of onset of
Sudden death
symptoms or during sleep
• Death due to progressive
Heart failure
myocardial failure
• Death before hospital discharge or
Perioperative death
<30 days of cardiac surgery
Other cardiovascular • Myocardial infarction, pulmonary
death emboli, hemoptysis, stroke
Non-cardiovascular
• Other causes of death
death
Definitions
Ventricular • At least moderate (EF <40%)
dysfunction dysfunction
Valvular heart • At least moderate stenosis or
disease regurgitation
• Cardiac catheterization: mean PAP
Pulmonary
>25 mm Hg; or
hypertension
• Doppler-echo: sys PAP >40 mm Hg
Bonow et al. Circulation 2006;114:e84-231
Badesch et al. JACC 2009;54:S55-66
Baseline characteristics
Characteristic N=378
Age 39 ± 13
Male gender 53%
IART / AF / IART and AF 63% / 34% / 3%
Prosthetic heart valve 28%
NYHA I / II / III 64% / 28% / 8%
Valvular heart disease 41%
Subaortic ventricular dysfunction 27%
Pulmonary hypertension 21%