Author + information
- Received October 15, 2018
- Revision received December 20, 2018
- Accepted January 2, 2019
- Published online May 20, 2019.
- Alexander C. Egbe, MD, MPH∗ (, )
- William R. Miranda, MD,
- Naser M. Ammash, MD,
- Sindhura Ananthaneni, MD,
- Harigopal Sandhyavenu, MD,
- Mohamed Farouk Abdelsamid, MD,
- Vidhushei Yogeswaran, MD,
- Suraj Kapa, MD,
- Ayotola Fatola, BSc,
- Srikanth Kothapalli, MD and
- Heidi M. Connolly, MD
- ↵∗Address for correspondence:
Dr. Alexander C. Egbe, Mayo Clinic and Foundation, 200 First Street Southwest, Rochester, Minnesota 55905.
Objectives This study hypothesized that atrial fibrillation was associated with heart failure (HF) hospitalization, and that patients who received rhythm control therapy had a lower incidence of HF hospitalization and mortality.
Background Atrial fibrillation is a known risk factor for HF hospitalization and mortality in patients with acquired heart disease. Although atrial arrhythmias are common in adults with tetralogy of Fallot (TOF), data about prevalence and outcomes of therapy for atrial fibrillation are very limited.
Methods The MACHD (Mayo Adult Congenital Heart Disease) database was queried for adults with repaired TOF and documented atrial fibrillation from 1990 to 2017. Primary endpoint was HF hospitalization defined as admission for volume overload (pulmonary congestion and/or peripheral edema) requiring intravenous diuretics. Secondary endpoint was the effect of rhythm control therapy on HF hospitalization and all-cause mortality. Patients were divided into rhythm control and rate control groups based on the therapy initiated at the time of arrhythmia diagnosis.
Results Of 415 patients, 27 (7%) had 42 HF hospitalizations. Of these 415 patients, 88 (21%) had atrial fibrillation at age 49 ± 13 years. Atrial fibrillation was an independent risk factor for HF hospitalization (adjusted hazard ratio: 2.67; 95% confidence interval: 1.04 to 7.34; p = 0.045). The 88 patients were divided into the rhythm control group (n = 61, 69%) and the rate control group (n = 27, 31%). The rate control group had higher unadjusted annual incidence of HF hospitalization (13% vs. 3%; p = 0.001) and all-cause mortality (11% vs. 4%; p = 0.002).
Conclusions Atrial fibrillation was a risk factor for HF hospitalization and mortality in TOF patients, and rhythm control therapy was protective against these adverse events.
Dr. Egbe is supported by National Heart, Lung, and Blood Institute grant K23 HL141448-01. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received October 15, 2018.
- Revision received December 20, 2018.
- Accepted January 2, 2019.
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