Risk factors of atrial fibrillation progression in patients with congenital heart disease

OBJECTIVES: To identify risk factors for atrial fibrillation (AF) progression in adults with congenital heart disease (CHD), a population in which AF is increasingly prevalent yet predictors of progression remain poorly defined. METHODS: Adults with CHD and AF (N = 125) were followed for 17 ± 8 years. AF progression was defined as transition from paroxysmal to persistent/permanent AF. Coexisting atrial tachycardia, permanent pacing modes, and longitudinal changes in QRS duration (QRSd) and corrected QT interval (QTc) were evaluated. Time-dependent Cox regression and Fine-Gray competing risk models were used to identify risk factors for AF progression. RESULTS: AF progression occurred in 57 (45.6%) patients after a median of 5 (range: 0-30) years. Both QRSd and QTc prolongation were more pronounced in CHD patients with AF progression (AF progression ΔQRSd: + 11 ms, ΔQTc: + 28 ms, no-AF progression: ΔQRSd: + 7 ms, ΔQTc: + 11 ms, P < 0.05, respectively). Independent risk factors for AF progression included female sex (HR[95%CI] 2.3[1.3-3.9], P = 0.003), mild or moderate CHD complexity (HR[95%CI] 5.5[2.3-13.1], P < 0.001, and 4.4[1.8-11.0], P = 0.002) and baseline ventricular pacing (HR[95%CI] 5.9[2.5-13.7], P < 0.001). Similar associations were observed in Fine-Gray analyses accounting for death. CONCLUSIONS: In adults with CHD, AF progression is common and associated with more pronounced ventricular electrical remodeling. Both modifiable (pacing mode) and intrinsic (sex and CHD complexity) risk factors are related to AF progression. These findings enable identification of high-risk CHD patients for AF progression and provide a foundation for future studies on targeted monitoring or treatment.