Progression of late postoperative atrial fibrillation in patients with tetralogy of Fallot

Introduction: ToF patients are at risk for ventricular deterioration at a relatively young age, which can be aggravated by AF development. Therefore, knowledge on AF development and its timespan of progression is essential to guide treatment strategies for AF. Objective: We examined late postoperative AF onset and progression in ToF patients during long-term follow-up after ToF correction. In addition, coexistence of AF with regular supraventricular tachyarrhythmias (SVT) and ventricular tachyarrhythmias (VTA) was analyzed. Methods and results: ToF patients (N = 29) with AF after ToF correction referred to the electrophysiology department between 2000 and 2015 were included. All available rhythm registrations were reviewed for AF, regular SVT, and VTA. AF progression was defined as transition from paroxysmal AF to (longstanding) persistent/permanent AF or from (longstanding) persistent AF to permanent AF. At the age of 44 ± 12 years, ToF patients presented with paroxysmal (N = 14, 48%), persistent (N = 13, 45%) or permanent AF (N = 2, 7%). Age of AF development was similar among patients who either underwent initial shunt creation (N = 15, 45 ± 11 [25–57] years) or primary total ToF correction (N = 14, 43 ± 13 [26–66] years) (P = 0.785). AF coexisted with regular SVT (N = 18, 62%) and VTA (N = 13, 45%). Progression of AF occurred in 11 patients (38%) within 5 ± 5 years after AF onset despite antiarrhythmic drug class II (AAD, P = 0.052) or III (P = 0.587) usage. Conclusions: AF in our ToF population developed at a young age and showed rapid progression. Rhythm control by pharmacological therapy was ineffective in preventing AF progression.

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