Risk factors of supraventricular arrhythmia in adults with congenital heart disease.
BACKGROUND
Supraventricular arrhythmia (SVA) is a frequent clinical complication in adult patients with congenital heart disease (CHD). The aim of this study is prognostic evaluation of congenital heart defect complexity, performed cardiac surgery, initial functional impairment of the heart - NYHA > I, cyanosis, age and sex of the adult patients with CHD, presenting for the first time to an outpatient clinic, on SVA occurrence during long-term observation.


METHODS
We looked at 1,304 patients (586 men), aged 18-72 years (mean 29.4 +/- 10.6 years), and followed-up from 1995 to 2004. The mean observation period was 3.52 +/- 1.83 years. SVA in the form of atrial flutter/fibrillation (FA/FLA) and supraventricular tachycardia was observed in 133 patients, 10.3% of the study population. Ten-year follow-up showed that the likelihood of SVA occurrence in the whole studied population after two years was 5.2%, and 14.4% after ten years.


RESULTS
Univariate analysis proved that the incidence of SVA is greater in patients with complex heart defects (p = 0.0001), those not previously operated upon (p = 0.0001), those with baseline impairment of cardiac function (NYHA > I; p = 0.0001) and those with cyanosis (0.0001). The patient's sex seems to have little significance. Cox regression analysis showed that baseline heart failure is the strongest risk factor for SVA (HR = 4.66). Congenital heart defect complexity (HR = 2.31) and the patient's age are also significant prognostic factors of this arrhythmia (HR = 1.32). Cardiac surgery, cyanosis and patient sex are not significant in prognosis.


CONCLUSIONS
Baseline impairment of heart function, heart defect complexity and patient's age all increase the risk of SVA in the population of adults with congenital heart disease. Cyanosis and the lack of cardiac surgery in the past led to a higher incidence of the analyzed arrhythmia but are not risk factors for its occurrence. Gender has no prognostic significance for SVA.
Department of Cardiology, Poznań University of Medical Science, Poland. olgatroj@wp.pl
Olga
O
Trojnarska
Stefan
S
Grajek
Lucyna
L
Kramer
Adrian
A
Gwizdała
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D001281:Atrial Fibrillation / Q000209:etiology; D001282:Atrial Flutter / Q000209:etiology; D006348:Cardiac Surgical Procedures; D003490:Cyanosis / Q000150:complications; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013617:Tachycardia, Supraventricular / Q000209:etiology; D013997:Time Factors; D055815:Young Adult