J Korean Med Sci.  2021 Feb;36(5):e43. 10.3346/jkms.2021.36.e43.

Impact of Atrial Fibrillation on Survival in Adults with Congenital Heart Disease: a Retrospective Population-based Study

• Jang SY
• Huh J
• Kim EK
• Chang SA
• Song J
• Kang IS
• Park SW

• KMID: 2512465
• DOI: http://doi.org/10.3346/jkms.2021.36.e43

Abstract

Background
The number of adults with congenital heart disease (ACHD) with atrial fibrillation (AF) is expected to increase. We sought to assess the impact of AF on survival in Korean ACHD.
Methods
Records of AF in ACHD were extracted from the records of the Korea National Health Insurance Service from 2006 through 2015. Multiple Cox proportional hazards analyses were carried out after adjustment for age, sex, income level, AF, and comorbidities.Survival rates (SRs) with and without AF were compared. The death records from 2006 through 2016 were included.
Results
A total of 3,999 ACHD had AF (51.4% were male) and 62,691 ACHD did not have AF (43.5% were male); the proportion of ACHD who were 60 years and older was 53.0% and 27.0% in those with and without AF, respectively (P < 0.001). The age-standardized incidence rate for AF was 1,842.0 persons per 100,000 people in the Korean general population from 2006 through 2015. For AF in ACHD, it was 5,996.4 persons per 100,000 ACHD during the same period, which was higher than that in the general population (P< 0.001). Significantly higher proportion of death (20.9%) occurred in ACHD with AF than without AF (8.3%) (P< 0.001). The adjusted hazard ratio for AF of death in ACHD was 1.39 (95% confidence interval, 1.29– 1.50). The ten-year SR of ACHD with AF was 69.7% whereas it was 87.5% in non-AF (P < 0.001).
Conclusion
In ACHD, AF occurs more frequently and has a worse prognosis than seen in the non-valvular general population in Korea. AF is associated with increased death in ACHD, especially with aging.

Keyword

Atrial Fibrillation; Atrial Fibrillation; Survival; Survival; Congenital Heart Defect; Congenital Heart Defect; Adult; Adult

Figure

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  Fig. 1 Distribution between newly diagnosed AF patients in ACHD (n = 3,999) and non-valvular AF in the Korean general population10 (n = 679,476).AF = atrial fibrillation, ACHD = adults with congenital heart disease.

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  Fig. 2 Survival curve of ACHD in Korea by AF. (A) ACHD survival rates by AF (P < 0.001), (B) by AF and age group (P < 0.001), (C) by AF and sex (P < 0.001).AF = atrial fibrillation, ACHD = adults with congenital heart disease.

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