The Clinical Characteristics of Atrial Fibrillation after Repair of Tetralogy of Fallot

Abstract

Background: Atrial tachyarrhythmias caused by right atrial enlargement are one of the main concerns in patients after repair of tetralogy of Fallot (TOF). However, few reports exist about atrial fibrillation (AF) in TOF patients. Methods and Results: We retrospectively reviewed the clinical characteristics of AF in 6 patients and compared those with 36 with atrial tachycardia and/or intraatrial reentrant tachycardia (AT/IART). The age at the onset of AF was 35±9 years. Three had persistent AF and 3 had paroxysmal AF. All 3 with persistent AF showed New York Heart Association (NYHA) class III, and the cardiothoracic ratio in persistent AF was higher than paroxysmal AF (73±7 vs. 55±4%, p=0.047). Two with paroxysmal AF and IART underwent the catheter ablation for IART and resulted in no recurrence of AF. The age at the repair (16±10 vs. 6±9 years, p=0.02), and the proportion of NYHA≥II (80 vs. 31%, p=0.02) were higher in AF patients than lone AT/IART. There were no differences in cardiac performance between AF and AT/IART. Conclusion: The AF-TOF patients are more clinically symptomatic than those of AT/IART, although no obvious hemodynamic differences. The mechanisms of AF in TOF may differ from those of the hearts without congenital heart disease.