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Predictors of Atrial Arrhythmia in Adults with Repaired Tetralogy of Fallot

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Abstract

Tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease in adults, has excellent long-term survival. However, many patients (30–45%) develop late arrhythmias. Previous studies have identified predictors of arrhythmia (atrial or ventricular) using clinical markers that predate arrhythmia onset by many years. Our objective was to develop a predictive model for incident atrial arrhythmias within two years of clinical evaluation and diagnostic testing. A single-center nested unmatched case-control study of 174 adults with repaired TOF. We included only patients with results from ECG and echocardiogram data in the required time interval (3–24 months before first arrhythmia for cases; 24 months of follow-up for controls). A predictive multivariable model for risk of incident atrial arrhythmia was developed using logistic regression with a least absolute shrinkage and selection operator (LASSO). Of 41 demographic, surgical, and diagnostic variables, six were selected as having predictive value for atrial arrhythmia based on cross validation. The factors with the greatest predictive value in decreasing order were moderate / severe tricuspid regurgitation (adjusted odds ratio (OR) 149.42), QRS fragmentation (OR 28.08), severe pulmonary regurgitation (OR 8.22), RV systolic dysfunction (OR 2.95), 1st degree AV block (OR 2.59), and age at time of surgical repair (OR 1.02). Predictors for atrial arrhythmia in our study suggested abnormal right ventricle anatomical function and electrophysiologic properties (conduction and repolarization) as the primary underlying substrate.

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Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

AF:

atrial fibrillation

AFL:

atrial flutter

AT:

atrial tachycardia

AVNRT:

atrioventricular nodal reentrant tachycardia

BTT shunt:

Blalock-Thomas-Taussig shunt

CHB:

complete heart block

CHF:

congestive heart failure

cMRI:

cardiac magnetic resonance imaging

IART:

intra-atrial reentry tachycardia

ICD:

implantable cardioverter-defibrillator

LA:

left atrial

LV:

left ventricular

LVEF:

left ventricular ejection fraction

OR:

odds ratio

PAC:

premature atrial contraction

PVC:

premature ventricular contraction

PVR:

pulmonary valve replacement

RA:

right atrial

RV:

right ventricular

RVED:

right ventricular ejection fraction

RVEDVi:

indexed RV end diastolic volume

RVOT:

right ventricular outflow tract

SCA:

sudden cardiac arrest

SSS:

sick sinus syndrome

SVT:

supraventricular tachycardia

TA:

transannular

TOF:

Tetralogy of Fallot

TR:

tricuspid regurgitation

TTE:

transthoracic echocardiogram

VF:

ventricular fibrillation

VSD:

ventricular septal defect

VT:

ventricular tachycardia

WACH:

Washington Adult Congenital Heart

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Authors and Affiliations

  1. George Washington University School of Medicine & Health Sciences, Washington, DC, USA

    Zachary E. Falk

  2. Department of Biostatistics and Bioinformatics, George Washington University Milken Institute of Public Health, Washington, DC, USA

    Annette M. Aldous

  3. Division of Cardiology, Children’s National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA

    Seiji Ito & Jeffrey P. Moak

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Contributions

ZEF - made substantial contributions to the conception of the work; acquisition, analysis, and interpretation of data, and writing of the MSAMA - made substantial contributions to the conception of the work; acquisition, analysis, and interpretation of data, and writing of the MSSI - made substantial contributions to the conception of the work; interpretation of data, and writing of the MSJPM - made substantial contributions to the conception of the work; analysis, and interpretation of data, and writing of the MS.

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Correspondence to Jeffrey P. Moak.

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Falk, Z.E., Aldous, A.M., Ito, S. et al. Predictors of Atrial Arrhythmia in Adults with Repaired Tetralogy of Fallot. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03436-6

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