PO-04-145 ATRIAL FIBRILLATION AND PULMONARY HYPERTENSION IN ADULT CONGENITAL HEART DISEASE

Abstract

ith the improvement of surgery and perioperative care, the survival of congenital heart disease (CHD) has improved much in recent decades. The long-term complication especially atrial fibrillation (Af) has gained attention. With a large ACHD cohort, we tried to find out the epidemiology data and risk factors of Af in adult CHD patients and see the impact of Af on the late outcome. From 2007 to 2018, all patients older than 18 years of age and diagnosed as CHD in National Taiwan University Hospital were enrolled in our study. The basic clinical characteristics, ECG and Holter result, and follow-up data were collected through the National Taiwan University Hospital-Integrated Medical Database. Atrial fibrillation status was categorized as persistent Af, paroxysmal Af, and atrial flutter (AFL). CHD was categorized as simple, severe, or complex CHD (according to the World Symposia on Pulmonary Hypertension classification). There were 4403 patients (women, 55.9%), 15.4% with severe and 3.9% with complex CHD. The cumulative incidence of Af was 6.9% (54.7% as paroxysmal Af, 26.9% as persistent Af, and 18.4% as AFL). Mean onset age of AFL, paroxysmal Af, and persistent Af was 35.7±15.8, 48.4±19.3, and 57.2±14.3 years-old. The 70-years old cardiovascular accident (CVA) free survival rate was 67.1% in those with Af (vs. 80.7% in those without, p<0.001). The 5 years CVA free survival rate since the onset of Af was low in paroxysmal and persistent Af (71.2% and 72.1%) compared to those of AFL (91.5%, p=0.004). Patients with pulmonary hypertension has significantly higher risk of Af. The multivariable regression model indicated that Af and PAH were most significant risk factors of mortality (odds ratio 2.8 (95% CI 2.0-4.0) and 9.4 (95% CI 6.6-13.2) respectively, both p<0.001). In this large ACHD cohort, the cumulative incidence of Af was high, increasing with age and presence of PH. CVA and Mortality increased with presence of Af.