title: Frequent atrial extrasystolic beats predict atrial fibrillation in patients with congenital heart defects.
abstract: Atrial fibrillation (AF) is increasingly observed in patients with congenital heart defects (CHDs) who survive nowadays into adulthood. Yet, predictors of AF are scarce in this high-risk population. This study therefore examined the predictive ability of atrial extrasystole (AES) for development of AF in CHD patients.
  
  
  
  Adult CHD patients who had a 24 h Holter registration were followed to determine who developed AF. A total of 573 patients (49% male, mean age 35 ± 12 years) were included; they had a simple/complete repaired CHD (n = 279), complex repaired CHD (n = 251), or univentricular heart (UVH, n = 43). Ageing (P < 0.0001), female gender (P = 0.028), UVH (P = 0.0010), and left atrial dilatation (P = 0.0025) were associated with the number of AES. During a median follow-up of 51.6 months (interquartile range 22.8-85.7), 29 patients (5%) developed de novo AF. An one-point increase in the number of logtotal-AES was associated with a two-fold higher risk of AF development (hazard ratio 1.95; 95% confidence interval 1.21-3.13; P = 0.016). C-statistic for left atrial dilatation, complexity, and age had a good discriminative ability for the incidence of AF with a C-statistic of 84.5%. The addition of the total number of AES/24 h to this model increased C-statistic to 88.4%.
  
  
  
  Atrial extrasystole occur relatively frequent in adult CHD patients compared with patients with other cardiac diseases. This is the first study that showed an association between an increased AES frequency and a higher risk of AF development in CHD patients.
authors.affiliation: Translational Electrophysiology, Department of Cardiology, Erasmus University Medical Center, Thorax Center, PO Box 616, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Christophe P
authors.initials: CP
authors.lastname: Teuwen
authors.affiliation: Rotterdam Thyroid Center and Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Tim I M
authors.initials: TIM
authors.lastname: Korevaar
authors.affiliation: Translational Electrophysiology, Department of Cardiology, Erasmus University Medical Center, Thorax Center, PO Box 616, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Rosa L
authors.initials: RL
authors.lastname: Coolen
authors.affiliation: Translational Electrophysiology, Department of Cardiology, Erasmus University Medical Center, Thorax Center, PO Box 616, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Twan
authors.initials: T
authors.lastname: van der Wel
authors.affiliation: Translational Electrophysiology, Department of Cardiology, Erasmus University Medical Center, Thorax Center, PO Box 616, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Houck
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Reinder
authors.initials: R
authors.lastname: Evertz
authors.affiliation: Department of Cardiology, Haga Hospital, The Hague, The Netherlands.
authors.forename: Ameeta
authors.initials: A
authors.lastname: Yaksh
authors.affiliation: Translational Electrophysiology, Department of Cardiology, Erasmus University Medical Center, Thorax Center, PO Box 616, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ad J J C
authors.initials: AJJC
authors.lastname: Bogers
authors.affiliation: Translational Electrophysiology, Department of Cardiology, Erasmus University Medical Center, Thorax Center, PO Box 616, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Natasja M S
authors.initials: NMS
authors.lastname: de Groot
mesh_terms: D000200:Action Potentials; D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D018880:Atrial Premature Complexes / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: Atrial extrasystole; Atrial fibrillation; Congenital heart defects; Risk stratification