Arrhythmia Burden Among Adult Patients With Congenital Heart Disease: A Population-Based Study

Abstract

Background: A significant percentage of patients with congenital heart disease surviving into adulthood will develop arrhythmias. These arrhythmias are associated with an increased risk of adverse events and death. We aimed to assess arrhythmia prevalence, risk factors, and associated health care usage in a large national cohort of patients with adult congenital heart disease.

Methods and results: Adults with a documented diagnosis of congenital heart disease, insured by Clalit and Maccabi health services between January 2007 and December 2011, were included. We assessed the associations between arrhythmia and subsequent hospitalization rates and death with mixed negative binomial and Cox proportional hazard models, respectively. Among 11 653 patients with adult congenital heart disease (median age, 47 years [interquartile range, 31-62]), 8.7% had a tachyarrhythmia at baseline, 1.5% had a conduction disturbance, and 0.5% had both. Among those without a baseline arrhythmia, 9.2% developed tachyarrhythmias, 0.9% developed a conduction disturbance, and 0.3% developed both during the study period. Compared with no arrhythmia (reference group), arrhythmia in the previous 6 months was associated with a higher multivariable adjusted hospitalization rate, 1.33-fold higher than the rate of the reference group (95% CI, 1.00-1.76) for ventricular arrhythmia, 1.27-fold higher (95% CI, 1.17-1.38) for atrial arrhythmias, and 1.33-fold higher (95% CI, 1.04-1.71) for atrioventricular block. Atrial tachyarrhythmias were associated with an adjusted mortality hazard ratio (HR) of 1.65 (95% CI, 1.44-2.94), and ventricular tachyarrhythmias with a >2-fold increase in mortality risk (HR, 2.06 [95% CI, 1.44-2.94]).

Conclusions: Arrhythmias are significant comorbidities in the adult congenital heart disease population and have a significant impact on health care usage and survival.

Keywords: adult congenital heart disease; arrhythmias; health care usage.

Figure 1. Relative number of hospital admissions and days in hospital among 11 653 patients with ACHD by arrhythmia type.

Reference=no arrhythmia. AV indicates atrioventricular; BB, bundle branch; ICU, intensive care unit; PM, premature; and RR, relative rate.

Figure 2. Crude mortality rate per arrhythmia subgroup.

Figure 3. Multivariable adjusted outcome HR by arrhythmia type.

Arrhythmia variables considered in multivariable analysis included atrial tachyarrhythmia, ventricular tachyarrhythmia, other tachyarrhythmia, atrioventricular block, bundle branch block, and premature beat. AV indicates atrioventricular; BB, bundle branch; HR, hazard ratio; and PM, premature.