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

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Tetralogy of Fallot (ToF) is the most prevalent cyanotic congenital heart disease (CHD);1 approximately 4% of all patients with CHD are diagnosed with ToF.2 As a result of improved medical care and advances in surgical techniques since the 1950s, more than 85% of the ToF patients nowadays survive into adulthood.1
However, new challenges arose since long‐term complications, such as tachyarrhythmias, became more prevalent. In the registry of the Alliance for Adult Research in Congenital Cardiology (AARCC), up to 43% of the 556 ToF patients had tachyarrhythmias.3
In previous studies, ventricular tachyarrhythmias (VTA) with potentially devastating consequences were frequently observed.4 However, the prevalence of supraventricular tachyarrhythmias (SVT) is also considerably high.6 SVT were present in 20% of the patients included in the AARCC registry; intra‐atrial reentrant tachyarrhythmias (IART) were most prevalent (12%) whereas 7% had atrial fibrillation (AF).
The incidence of AF increases with age and is more prevalent in ToF patients older than 55 years. The mechanism underlying AF development in ToF patients is unknown. Previous studies identified palliative shunting prior to total ToF correction as a predictor for SVT and AF.6 Also, it was suggested that regular SVT might facilitate development of AF in CHD patients.8
Due to multiple surgical procedures and often long‐term pressure and volume overload, ToF patients are at risk for ventricular deterioration at a relatively young age, which can be aggravated by AF development.9
Therefore, particularly in ToF patients, knowledge on AF development and its timespan of progression is essential to guide treatment strategies for AF. Individualized AF therapy may thereby contribute to maximal preservation of ventricular function in these patients.
The aims of this study were to examine (1) onset of AF in a cohort of patients who underwent total ToF correction in relation to clinical profiles and (2) progression of late, postoperative AF in ToF patients during long‐term follow‐up.
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