成人房室间隔缺损患者房性心律失常的发生率、危险因素和转归。

Incidence, Risk Factors, and Outcomes of Atrial Arrhythmias in Adult Patients With Atrioventricular Septal Defect.

机构信息

Electrophysiology Section, European Georges Pompidou Hospital, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Université de Paris, Inserm, Paris Cardiovascular Research Centre, Paris, France.

Louis Pradel Hospital, Lyon, France.

出版信息

JACC Clin Electrophysiol. 2022 Mar;8(3):331-340. doi: 10.1016/j.jacep.2021.09.004. Epub 2021 Oct 27.

DOI:10.1016/j.jacep.2021.09.004

PMID:35331427

Abstract

OBJECTIVES

This study aimed to assess the incidence, associated factors, and outcomes of atrial arrhythmias in adults with atrioventricular septal defect (AVSD).

BACKGROUND

Data regarding atrial arrhythmias in adults with AVSD are particularly scarce.

METHODS

Data were analyzed from a multicentric cohort of adult patients with AVSD. Lifetime cumulative incidences of atrial arrhythmias were studied. Multiple logistic regression models were used to identify risk factors.

RESULTS

A total of 391 patients (61.6% women) were enrolled with a mean age of 36.3 ± 16.3 years and a mean follow-up of 17.3 ± 14.2 years after initial surgical repair. Overall, 98 patients (25.1%) developed at least 1 episode of atrial arrhythmia at a mean age of 39.2 ± 17.2 years. The mean ages of patients at first episode of intra-atrial re-entrant tachycardia (IART)/ focal atrial tachycardia (FAT) and atrial fibrillation were 33.7 ± 15.3 and 44.3 ± 16.5 years, respectively. The lifetime risks for developing atrial arrhythmia to ages 20, 40, and 60 years were 3.7%, 17.8%, and 55.3%, respectively. IART/FAT was the leading arrhythmia until the age of 45, then atrial fibrillation surpassed IART/FAT. Age (odds ratio [OR]: 1.4; 95% confidence interval [CI]: 1.2-1.6), number of cardiac surgeries (OR: 4.1; 95% CI: 2.5-6.9), left atrial dilatation (OR: 3.1; 95% CI: 1.4-6.8), right atrial dilatation (OR: 4.1; 95% CI: 1.7-10.3), and moderate or severe left atrioventricular valve regurgitation (OR: 3.7; 95% CI: 1.2-11.7) were independently associated with a higher risk of atrial arrhythmias, whereas the type of AVSD and the age at repair were not. The occurrence of atrial arrhythmias was associated with pacemaker implantation (41.8% vs. 8.5%; P < 0.001), heart failure (24.5% vs. 1.0%; P < 0.001), and cerebrovascular accidents (11.2% vs. 3.4%; P = 0.007).

CONCLUSIONS

The lifetime risk of atrial arrhythmias in patients with AVSD is considerable with more than half of patients developing ≥1 atrial arrhythmia by the age of 60 and is associated with a significant morbidity. The risk in partial/intermediate AVSD is as high as in complete AVSD and is not impacted by age at repair.

摘要

目的

本研究旨在评估房室间隔缺损（AVSD）成人患者的房性心律失常的发生率、相关因素和结局。

背景

关于 AVSD 成人患者房性心律失常的数据特别缺乏。

方法

对 AVSD 成人患者的多中心队列进行数据分析。研究了房性心律失常的终生累积发生率。使用多元逻辑回归模型确定风险因素。

结果

共纳入 391 例（61.6%为女性）患者，平均年龄为 36.3±16.3 岁，初次手术修复后平均随访 17.3±14.2 年。总体而言，98 例（25.1%）患者在平均年龄为 39.2±17.2 岁时至少发生 1 次房性心律失常。首次出现房内折返性心动过速（IART）/局灶性房性心动过速（FAT）和心房颤动的患者平均年龄分别为 33.7±15.3 岁和 44.3±16.5 岁。到 20、40 和 60 岁时发生房性心律失常的终生风险分别为 3.7%、17.8%和 55.3%。IART/FAT 是主要的心律失常，直到 45 岁，然后心房颤动超过 IART/FAT。年龄（比值比[OR]：1.4；95%置信区间[CI]：1.2-1.6）、心脏手术次数（OR：4.1；95%CI：2.5-6.9）、左心房扩大（OR：3.1；95%CI：1.4-6.8）、右心房扩大（OR：4.1；95%CI：1.7-10.3）和中重度左房室瓣反流（OR：3.7；95%CI：1.2-11.7）与房性心律失常风险增加独立相关，而房室间隔缺损的类型和修复年龄则没有。房性心律失常的发生与起搏器植入（41.8%比 8.5%；P<0.001）、心力衰竭（24.5%比 1.0%；P<0.001）和脑血管意外（11.2%比 3.4%；P=0.007）有关。