Research in Cardiovascular Medicine

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 7  |  Issue : 4  |  Page : 182--186

The prevalence of arrhythmias in congenital heart patients and the response rate to antiarrhythmic treatment; A single center study


Mina Jamlou, Zahra Khajali, Amirfarjam Fazelifar, Mostafa Miri 
 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

Correspondence Address:
Dr. Mina Jamlou
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran
Iran

Abstract

Background: Congenital heart disease (CHD) in adults can be associated with several complications, one of the most important of these complications is cardiac arrhythmias. Accordingly, we decided to study the prevalence of arrhythmias in congenital heart patients and the response rate to antiarrhythmic in patients referred to Shahid Rajaee Hospital in the last 10 years. Materials and Methods: In this descriptive-analytical cross-sectional study, 110 patients with CHD referred to Shahid Rajaee Hospital in the last 10 years were selected and were included in the study. The incidence of arrhythmias was determined in them based on the electrocardiogram. In addition, the type of treatment and the response rate to the treatment were studied in patients. Results: In this study, the mean age of patients was 33.73 ± 13.15 years. Among patients, 59 (53.6%) cases were male and 51 (46.4%) were female. Three of the most common symptoms were palpation in 53 (48.2%) cases, dyspnea in 27 (24.5%), and vertigo in 16 (14.5%). The most common type of arrhythmias was atrial flutter in 35.5%, followed by atrial fibrillation in 28.2% and CHB 19.1%, respectively. The most commonly used type of treatment for patients was electrical cardioversion (32.7%), pace (23.6%), and drug cardioversion (22.7%), respectively. The response rate was 94.5% Returning to sinus rhythm, 3.6% continued arrhythmias, and 1.8% turned into other arrhythmias. Based on the duration of postoperative arrhythmias in patients, the highest frequency was observed for 10 years after surgery, which was observed in 49 (44.5%) patients, and thereafter 1 day after surgery in 18 (16.4%) and 1 week after surgery in 12 (10.9%) cases. The association of arrhythmias with treatments for patients regarding palliative status was investigated, which was not statistically significant (P = 0.774) the association of arrhythmias with treatments for patients regarding repaired was investigated, which was statistically significant (P = 0.0001). There is a significant relationship between arrhythmias with QRS duration (P = 0.0001). There is a significant relationship between arrhythmias with right ventricular aneurysm and cyanotic disease (P < 0.05). Conclusion: The current study provides an example of the frequency, diagnosis, and treatment of arrhythmia in patients with congenital heart failure. This study mainly focused on arrhythmias in adults with CHD. However, today, the majority of CHD can be treated with surgical or interventional therapy; however, it is not yet known how arrhythmias occur in patients with CHD.



How to cite this article:
Jamlou M, Khajali Z, Fazelifar A, Miri M. The prevalence of arrhythmias in congenital heart patients and the response rate to antiarrhythmic treatment; A single center study.Res Cardiovasc Med 2018;7:182-186


How to cite this URL:
Jamlou M, Khajali Z, Fazelifar A, Miri M. The prevalence of arrhythmias in congenital heart patients and the response rate to antiarrhythmic treatment; A single center study. Res Cardiovasc Med [serial online] 2018 [cited 2019 May 24 ];7:182-186
Available from: http://www.rcvmonline.com/text.asp?2018/7/4/182/249044


Full Text



 Introduction



Congenital heart disease (CHD) occurs during the development of the fetus in the uterus and can be inherited or acquired and affected by environmental factors, and 8–10 per 1000 live births develop these abnormalities[1],[2] With and without treatment, they can lead to child-related abnormalities (in 1 case per 1,000 live births),[3] or until adulthood are asymptomatic, in 47%–85% of cases, children with CHD can also survive until adulthood.[4],[5],[6] The most common CHDs in adults are valvular heart disease, atrial septal defect, ventricular septal defect, persistent foramen oval, ductus arteriosus, abnormalities in the return of corneal veins, Coarctation of the aorta, Epstein anomalies, pulmonary artery stenosis, and tetralogy of Fallot.[1],[2],[7],[8]

In mild cases, these diseases do not require treatment, and only conservative therapy is needed, and in severe cases, the need for therapeutic and surgical repair of abnormalities is necessary.[9],[10],[11] CHD in adults can be associated with several complications, one of the most important of these complications are cardiac arrhythmias.[12],[13]

Since the prevalence of this disorder is different in different societies, and the response rate to antiarrhythmic treatments is not the same in different demographic groups, the study in each population group has its own special significance. Accordingly, we decided to study the prevalence of arrhythmias in congenital heart patients and the response rate to antiarrhythmic in patients referred to Shahid Rajaee Hospital in the last 10 years.

 Materials and Methods



In this observational study, which was conducted as a cross-sectional analytical, descriptive study, inclusion criteria included CHD, and exclusion criteria were the inability to examine patients for arrhythmias due to defects in the patient's document or the uncertainty of the outcome of the antiarrhythmic treatments that has been done. The project was approved by the research council and ethics committee of the university. Finally, 110 patients with CHD referred to Shahid Rajaee Hospital in the last 10 years were selected and evaluated. The prevalence of arrhythmias in them was determined based on electrocardiogram (ECG) in the patients' records; hence, the type of treatment and the response rate to the treatment in the subjects was determined.

Statistical analysis

Data were analyzed by SPSS software version 20 (Softonic International, S.A., Barcelona, Spain). Quantitative findings were reported as mean and standard deviation and qualitative findings were reported as frequency and percentage. The analysis was performed using Chi-square and Fisher test, independent t-test, and logistic regression. The significance level was 0.05.

 Results



In this descriptive-analytic cross-sectional study, 800 cases of patients referred for the diagnosis of CHD were investigated. Among them, 110 (13.75%) patients with CHD were complicated with arrhythmia. It is necessary to provide descriptive information about the repair and palliative surgery performed over the past 10 years in the hospital, as shown in [Figure 1] and [Figure 2]. The mean age of patients in this study was 33.73 ± 13.15 years. 55 (50%) patients were <30 years old, and 55 (50%) were over 30 years old. Among patients, 59 (53.6%) were male, and 51 (46.4%) were female [Figure 3].{Figure 1}{Figure 2}{Figure 3}

The symptoms of the patients were studied, the most common symptoms was palpation in 53 (48.2%) cases, dyspnea in 27 (24.5%) cases, and vertigo in 16 (14.5%) cases. Moreover, the least symptoms were chest pain, which was seen in 1 (0.9%).

Risk factors in patients were studied. Of the patients, 3 cases (2.7%) were risk free and 107 (97.3%) had at least one risk factor. The most common risk factors were RA enlargement in 84 (76.4%) ̨ HF in 77(70%) and LA enlargement in 22 (20%) cases [Table 1].{Table 1}

The most common type of arrhythmias was atrial flutter (AFL) in 35.5%, followed by atrial fibrillation (AF) in 28.2% and CHB 19.1%, respectively. The most commonly used type of treatment for patients was electrical cardioversion (32.7%), pace (23.6%), and drug cardioversion (22.7%), respectively. The response rate was 94.5% returning to sinus rhythm, 3.6% continued arrhythmias, and 1.8% turned into other arrhythmias [Table 2].{Table 2}

The frequency of arrhythmias, type of treatment and response to treatment was investigated based on gender, age (<30 years and more than 30 years), and the presence and absence of risk factors in patients. In the meanwhile, only relationship between the type of arrhythmia with gender was statistically significant (P = 0. 040), and in other cases, this relationship was not observed.

In addition, the duration of arrhythmia after surgery in the patient was evaluated that highest frequency was observed for 10 years after surgery, which was observed in 49 (44.5%) patients, and thereafter 1 day after surgery in 18 (16.4%) and 1 week after surgery in 12 (10.9%) cases.

The presence of right ventricular (RV) aneurysm was evaluated in patients who had this problem in 18 (16.4%) patients. QRS Duration was also evaluated in patients with the following results: 27 (25.5%) were normal, 70 (63.6%) cases were between 120 and 160 and 13 (11.8%) more than 160. In addition, in 12 (10.9%) patients, Eisenmenger syndrome was seen.

In patients, treatments were performed for patients regarding repaired, unrepaired, and palliative on the basis of CHD, the results of which are shown in [Table 3], [Table 4], [Table 5].{Table 3}{Table 4}{Table 5}

The association of arrhythmias with treatments for patients regarding palliative status was investigated, which was not statistically significant (P = 0.774). The relationship between arrhythmias and treatments performed for patients regarding repaired which was statistically significant (P = 0.0001).

There is a significant relationship between arrhythmias with QRS duration (P = 0.0001). There is a significant relationship between arrhythmias with RV aneurysm (P = 0.033). On the other hand, among arrhythmias with cyanotic disease. There is a significant relationship (P = 0.046).

 Discussion



Patients with CHD are a heterogeneous population that shows the diagnosis and various complications of arrhythmias. Over the past decades, there has been a lot of progress in our understanding of arrhythmic mechanisms and treatment options. The current knowledge and understanding of arrhythmia in adults or people with CHD are developing rapidly, due to the prolonged life of these patients and the use of innovative therapies designed and tested in patients without CHD. In the same study, Mondésert et al.,[14] published as a review study, found that cardiac arrhythmias, especially in some CHDs, are more important in adults, including Tetralogy of Fallot and in other CHD, prophylaxis with anticoagulant drugs, and periodic examinations are sufficient. To increase the knowledge and the status of arrhythmias, in this case, the current study aimed to investigate the prevalence of arrhythmias in congenital heart patients and the response rate to antiarrhythmic treatment in patients referred to Shahid Rajaee Hospital in the last 10 years.

In this study, the mean age of patients in this study was 33.73 ± 13.15 years. Among patients, 59 (53.6%) were male, and 51 (46.4%) were female. The most common symptoms was palpation in 53 (48.2%) cases, dyspnea in 27 (24.5%) cases and vertigo in 16 (14.5%) cases. Moreover, the least symptoms were chest pain, which was seen in 1 (0.9%). The most common risk factors were HF in 77 (70%) cases, RA enlargement in 84 (76.4%), and LA enlargement in 22 (20%) cases. In our study, the most common type of arrhythmias was AFL in 35.5%, followed by AF in 28.2% and CHB 19.1%, respectively. The most commonly used type of treatment for patients was electrical cardioversion (32.7%), pace (23.6%), and drug cardioversion (22.7%), respectively. The response rate was 94.5% returning to sinus rhythm, 3.6% continued arrhythmias, and 1.8% turned into other arrhythmias.

In a study by Rodriguez et al.,[20] a study of 140 patients with CHD showed that 15% of them had erythema, which in 76% of cases was asymptomatic and did not require treatment. As our study in Clark and Berul,[17] published in an overview in 2015, stated that, although atrial arrhythmias are more common in patients with CHD, the risk of ventricular arrhythmias, especially in patients with Tetralogy of Fallot or aortic stenosis, are higher. In our study, the prevalence of atrial arrhythmias was highest.

In the study of Priromprintr et al.,[16] 170 patients with CHD were studied. During the exercise test, ventricular premature complexes were developed in 44% of patients, which, after completing the exercise test, resolved arrhythmias and did not require treatment. However, the difference between this study and our study was the type of study design that the development of arrhythmia in the study of Priromprintr et al.[16] was regarding exercise and stress testing. However, in our study, only data on the basis of the ECG were reviewed. In addition, in our study, arrhythmias were more of atrium type.

In our study, frequency of arrhythmias, type of treatment, and response to treatment were investigated based on gender, age (<30 years and more than 30 years), and the presence and absence of risk factors in patients. In the meanwhile, only relationship between the type of arrhythmia with gender was statistically significant (P = 0. 040), and in other cases, this relationship was not observed.

In a similar study, in a study by Koyak et al.,[15] in 2013, a total of 419 patients with CHD were examined and 32% of them had arrhythmias that includes supraventricular tachycardia, bradycardia, and ventricular tachycardia. Patients older than 40 years and New York Heart Association Class 2 and high creatine phosphokinase levels were associated with arrhythmias in patients. The difference in this study with our study was that the number of samples in our study was much lower. There was also no association between age and arrhythmias, and in addition, in our study, laboratory factors were not investigated, which itself emphasizes the study of this characteristic in future studies.

In Another study by Khairy and Balaji[21] found that arrhythmia was highly prevalent in patients with CHD and was associated with variables such as age and type of arrhythmias, and the type of CHD, and their treatment required anatomical and Physiologic examination of patients.

In our study, the duration of arrhythmia after surgery in the patient was evaluated that the highest frequency was observed for 10 years after surgery, which was observed in 49 (44.5%) patients, and thereafter 1 day after surgery in 18 (16.4%) and 1 week after surgery in 12 (10.9%) cases also The presence of RV aneurysm was evaluated in patients who had this problem in 18 (16.4%) patients.

In a review study, published in 2008 by Szili-Torok et al., found that the origin of arrhythmias in patients with CHD could be from the normal tissue of the heart or parts of the scar caused by antiarrhythmic treatments. Ablative treatment is effective in improving atrial and ventricular arrhythmias that originate from the normal tissue of the heart.[18]

The results of this study and other studies have shown that the differences may be due to differences in the type of design study, the difference in the method of examination of arrhythmias and the number of samples that examined.[19]

 Conclusion



The current study provides an example of the frequency, diagnosis, and treatment of arrhythmia in patients with congenital HF. This study mainly focused on arrhythmias in adults with CHD. The results showed that the most common type of arrhythmia was respectively, AFL, followed by AF and CHB, and there was a relationship between sex and type of arrhythmia, but with interventions, more than 90% of patients returned to normal rhythm. However, today, the majority CHD can be treated with surgical or interventional therapy; however, it is not yet known how arrhythmias occur in patients with CHD.

Limitations and suggestions

According to the results of the study, there are still significant constraints on the understanding and management of various types of arrhythmias that should be considered in the future. Among the limitations of this study, the incompleteness of the records was due to ECG and arrhythmia registrations, which caused the number of samples entered into the study to be limited, and therefore, a more accurate registration system should be used in these patients. On the other hand, further advances and further studies on imaging and arrhythmic imaging technologies that allow accurate identification of arrhythmias may improve the results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Moodie DS. Diagnosis and management of congenital heart disease in the adult. Cardiol Rev 2001;9:276-81.
2Fishberger S. Management of ventricular arrhythmias in adults with congenital heart disease. Curr Cardiol Rep 2002;4:76-80.
3Moodie DS. Adult congenital heart disease. Ochsner J 2002 Fall;4:221-6.
4Reid GJ, Irvine MJ, McCrindle BW, et al. Prevalence and correlates of successful transfer from pediatric to adult health care among a cohort of young adults with complex congenital heart defects. Pediatrics 2004;113(3 Pt 1):e197-205.
5Morphet JA. Adult congenital heart disease. Can J Cardiol 2006;22:157.
6Dearani JA, Connolly HM, Martinez R, Fontanet H, Webb GD. Caring for adults with congenital cardiac disease: Successes and challenges for 2007 and beyond. Cardiol Young 2007;17 Suppl 2:87-96.
7Szili-Torok T, Kornyei L, Jordaens LJ. Transcatheter ablation of arrhythmias associated with congenital heart disease. J Interv Card Electrophysiol 2008;22:161-6.
8Khairy P, Balaji S. Cardiac arrhythmias in congenital heart diseases. Indian Pacing Electrophysiol J 2009;9:299-317.
9Jalkut MK, Allen PJ. Transition from pediatric to adult health care for adolescents with congenital heart disease: A review of the literature and clinical implications. Pediatr Nurs 2009;35:381-7.
10Moodie D. Adult congenital heart disease: Past, present, and future. Tex Heart Inst J 2011;38:705-6.
11Daliento L, Cecchetto A, Bagato F, Dal Bianco L. A new view on congenital heart disease: Clinical burden prevision of changing patients. J Cardiovasc Med (Hagerstown) 2011;12:487-92.
12van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis. J Am Coll Cardiol 2011;58:2241-7.
13Rodriguez FH, Moodie DS, Neeland M, Adams GJ, Snyder CS. Identifying arrhythmias in adults with congenital heart disease by 24-h ambulatory electrocardiography. Pediatr Cardiol 2012;33:591-5.
14Romfh A, Pluchinotta FR, Porayette P, Valente AM, Sanders SP. Congenital Heart Defects in Adults: A Field Guide for Cardiologists. J Clin Exp Cardiolog 2012;(Suppl 8):7.
15van der Bom T, Bouma BJ, Meijboom FJ, Zwinderman AH, Mulder BJ. The prevalence of adult congenital heart disease, results from a systematic review and evidence based calculation. Am Heart J 2012;164:568-75.
16Mondésert B, Abadir S, Khairy P. Arrhythmias in adult congenital heart disease: The year in review. Curr Opin Cardiol 2013;28:354-9.
17Koyak Z, Achterbergh RC, de Groot JR, et al. Postoperative arrhythmias in adults with congenital heart disease: Incidence and risk factors. Int J Cardiol 2013;169:139-44.
18Ejim E, Anisiuba B, Oguanobi N, et al. Congenital heart diseases in adults: A review of echocardiogram records in enugu, South-East Nigeria. Ann Med Health Sci Res 2014;4:522-5.
19Priromprintr B, Rhodes J, Silka MJ, Batra AS. Prevalence of arrhythmias during exercise stress testing in patients with congenital heart disease and severe right ventricular conduit dysfunction. Am J Cardiol 2014;114:468-72.
20Clark BC, Berul CI. Arrhythmia diagnosis and management throughout life in congenital heart disease. Expert Rev Cardiovasc Ther 2016;14:301-20.
21Ministeri M, Alonso-Gonzalez R, Swan L, Dimopoulos K. Common long-term complications of adult congenital heart disease: Avoid falling in a H.E.A.P. Expert Rev Cardiovasc Ther 2016;14:445-62.