Arrhythmia Burden in Adults With Surgically Repaired Tetralogy of Fallot: A Multi-Institutional Study

Circulation. 2010 Aug 31;122(9):868-75. doi: 10.1161/CIRCULATIONAHA.109.928481. Epub 2010 Aug 16.

Abstract

Background: The arrhythmia burden in tetralogy of Fallot, types of arrhythmias encountered, and risk profile may change as the population ages.

Methods and results: The Alliance for Adult Research in Congenital Cardiology (AARCC) conducted a multicenter cross-sectional study to quantify the arrhythmia burden in tetralogy of Fallot, to characterize age-related trends, and to identify associated factors. A total of 556 patients, 54.0% female, 36.8+/-12.0 years of age were recruited from 11 centers. Overall, 43.3% had a sustained arrhythmia or arrhythmia intervention. Prevalence of atrial tachyarrhythmias was 20.1%. Factors associated with intraatrial reentrant tachycardia in multivariable analyses were right atrial enlargement (odds ratio [OR], 6.2; 95% confidence interval [CI], 2.8 to 13.6), hypertension (OR, 2.3; 95% CI, 1.1 to 4.6), and number of cardiac surgeries (OR, 1.4; 95% CI, 1.2 to 1.6). Older age (OR, 1.09 per year; 95% CI, 1.05 to 1.12), lower left ventricular ejection fraction (OR, 0.93 per unit; 95% CI, 0.89 to 0.96), left atrial dilation (OR, 3.2; 95% CI, 1.5 to 6.8), and number of cardiac surgeries (OR, 1.5; 95% CI, 1.2 to 1.9) were jointly associated with atrial fibrillation. Ventricular arrhythmias were prevalent in 14.6% and jointly associated with number of cardiac surgeries (OR, 1.3; 95% CI, 1.1 to 1.6), QRS duration (OR, 1.02 per 1 ms; 95% CI, 1.01 to 1.03), and left ventricular diastolic dysfunction (OR, 3.3; 95% CI, 1.5 to 7.1). Prevalence of atrial fibrillation and ventricular arrhythmias markedly increased after 45 years of age.

Conclusions: The arrhythmia burden in adults with tetralogy of Fallot is considerable, with various subtypes characterized by different profiles. Atrial fibrillation and ventricular arrhythmias appear to be influenced more by left- than right-sided heart disease.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arrhythmias, Cardiac / epidemiology*
  • Arrhythmias, Cardiac / therapy*
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / therapy
  • Atrial Flutter / epidemiology
  • Atrial Flutter / therapy
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pacemaker, Artificial / statistics & numerical data*
  • Prevalence
  • Pulmonary Atresia / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Tachycardia, Atrioventricular Nodal Reentry / epidemiology
  • Tachycardia, Atrioventricular Nodal Reentry / therapy
  • Tachycardia, Ventricular / epidemiology
  • Tachycardia, Ventricular / therapy
  • Tetralogy of Fallot / epidemiology*
  • Tetralogy of Fallot / surgery*
  • Young Adult