Keita Masuda1, Tomoko Ishizu2, Koichiro Niwa3, Fumie Takechi4, Shigeru Tateno4, Hitoshi Horigome5, Kazutaka Aonuma1. 1. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 2. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: tomoco@md.tsukuba.ac.jp. 3. Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan. 4. Department of Adult Congenital Heart Disease, Chiba Cerebral and Cardiovascular Center, Chiba, Japan. 5. Department of Child Health, University of Tsukuba, Tsukuba, Japan.
Abstract
BACKGROUND: Atrial tachyarrhythmias are a major morbidity in patients with adult congenital heart disease (ACHD). However, few studies have investigated risk stratification of thromboembolic events in ACHD patients with atrial tachyarrhythmias. METHODS AND RESULTS: This retrospective cohort study reviewed the clinical records of 2314 ACHD patients from 1977 to 2014. We found 242 (10.4%) patients with atrial tachyarrhythmias and excluded 84 patients already being treated with anticoagulant therapy. The remaining 158 patients without anticoagulant therapy were retrospectively followed up from the onset of atrial tachyarrhythmia to the incidence of thromboembolic events. Fourteen thromboembolic events and 5 hemorrhagic events occurred. All patients with thromboembolic events had atrial fibrillation (AF). Thromboembolic events occurred even in the patients with low or intermediate risk as indicated by CHADS2 or CHA2DS2-VASc score. Event rates were higher than those in data from the general adult population in previous studies. Univariate analysis revealed that age≥60years (OR 4.54, 95% CI 1.47-14.06, P=0.009), vascular disease (OR 7.83, 95% CI 1.19-51.53, P=0.032), and persistent AF (OR 5.60, 95% CI 1.73-18.11, P=0.004) were the independent risk factors of thromboembolic events. CONCLUSIONS: ACHD patients with atrial tachyarrhythmias and even those with low or intermediate risk as indicated by the CHADS2 or CHA2DS2-VASc score had a higher risk of thromboembolic events. Therefore, anticoagulation should be considered earlier than in the general population in patients with risk factors of age≥60years, vascular disease, or persistent AF.
BACKGROUND:Atrial tachyarrhythmias are a major morbidity in patients with adult congenital heart disease (ACHD). However, few studies have investigated risk stratification of thromboembolic events in ACHD patients with atrial tachyarrhythmias. METHODS AND RESULTS: This retrospective cohort study reviewed the clinical records of 2314 ACHD patients from 1977 to 2014. We found 242 (10.4%) patients with atrial tachyarrhythmias and excluded 84 patients already being treated with anticoagulant therapy. The remaining 158 patients without anticoagulant therapy were retrospectively followed up from the onset of atrial tachyarrhythmia to the incidence of thromboembolic events. Fourteen thromboembolic events and 5 hemorrhagic events occurred. All patients with thromboembolic events had atrial fibrillation (AF). Thromboembolic events occurred even in the patients with low or intermediate risk as indicated by CHADS2 or CHA2DS2-VASc score. Event rates were higher than those in data from the general adult population in previous studies. Univariate analysis revealed that age≥60years (OR 4.54, 95% CI 1.47-14.06, P=0.009), vascular disease (OR 7.83, 95% CI 1.19-51.53, P=0.032), and persistent AF (OR 5.60, 95% CI 1.73-18.11, P=0.004) were the independent risk factors of thromboembolic events. CONCLUSIONS: ACHD patients with atrial tachyarrhythmias and even those with low or intermediate risk as indicated by the CHADS2 or CHA2DS2-VASc score had a higher risk of thromboembolic events. Therefore, anticoagulation should be considered earlier than in the general population in patients with risk factors of age≥60years, vascular disease, or persistent AF.
Authors: Alexander C Egbe; William R Miranda; Naser M Ammash; Venkata R Missula; Raja Jadav; Maria Najam; Srikanth Kothapalli; Heidi M Connolly Journal: J Am Heart Assoc Date: 2019-03-05 Impact factor: 5.501