Abstract
Background
This study aimed to evaluate age at the first onset of cardiac complications and variation
of frequency of complications between different congenital heart defects.
Methods
The analysis included participants of the Swiss Adult Congenital Heart Disease Registry (SACHER). For this study, cardiac complications up to the time of inclusion
in SACHER were analysed. Complications included atrial fibrillation, atrial flutter,
supraventricular tachycardia, ventricular tachycardia, complete heart block, heart
failure, stroke, endocarditis, myocardial infarction, and pulmonary hypertension.
Incidence rates (IR; incidence rate per 1000 patient-years) for different age categories
and diagnosis groups were analysed.
Results
Of 2731 patients (55% male, mean age 34 ± 14 years, 92,349 patient-years), a total
of 767 (28%) had experienced at least 1 cardiac complication. The majority of complications
(550; 72%) occurred in adulthood (> 18 years). Apart from perioperative stroke (IR:
1.77 in age group ≤ 4 years) and complete heart block (IR: 2.36 in age group ≤ 4 years),
IR were much lower in childhood (IR < 1 for all complications between 5 and 17 years).
Incidence of cardiac complications increased during adult life with highest IR for
atrial fibrillation and atrial flutter in the age group ≥ 50 years (IR: 17.6 and 9.7,
respectively). There were important variations of the distribution of complications
among different diagnosis groups.
Conclusions
Cardiac complications are frequent in congenital heart disease. Apart from perioperative
stroke and complete heart block, IR are low in childhood but the incidence increases
during adult life. These data underscore the need of lifelong follow-up and may help
for better allocation of resources maintaining follow-up.
Résumé
Contexte
Cette étude visait à évaluer l’âge à l’apparition des complications cardiaques et
la variation de la fréquence des complications d’une cardiopathie congénitale à l’autre.
Méthodologie
L’analyse portait sur les patients inscrits au Swiss Adult Congenital Heart Disease Registry (SACHER). Aux fins de la présente étude, les complications cardiaques survenues
jusqu’au moment de l’inclusion du patient dans le registre SACHER ont été analysées.
Au nombre des complications figuraient la fibrillation auriculaire, le flutter auriculaire,
la tachycardie supraventriculaire, la tachycardie ventriculaire, le bloc cardiaque
complet, l’insuffisance cardiaque, l'accident vasculaire cérébral (AVC), l’endocardite,
l’infarctus du myocarde et l’hypertension pulmonaire. Les taux d’incidence (TI; taux
d’incidence pour 1000 années-patients) pour différents groupes de diagnostic et d’âge
ont été analysés.
Résultats
Sur 2731 patients (55 % de sexe masculin, âge moyen de 34 ± 14 ans, 92 349 années-patients),
767 au total (28 %) avaient eu au moins 1 complication cardiaque. La majorité des
complications (550; 72 %) étaient apparues à l’âge adulte (> 18 ans). À l’exception
de l’AVC périopératoire (TI : 1,77 dans le groupe d’âge ≤ 4 ans) et du bloc cardiaque
complet (TI : 2,36 dans le groupe d’âge ≤ 4 ans), les TI étaient beaucoup moins élevés
pendant l’enfance (TI < 1 pour toutes les complications entre 5 et 17 ans). L’incidence
des complications cardiaques augmentait au cours de la vie adulte, avec un TI atteignant
un maximum pour la fibrillation auriculaire et le flutter auriculaire dans le groupe
d’âge ≥ 50 ans (TI : 17,6 et 9,7, respectivement). Des variations importantes de la
distribution des complications ont été observées entre les différents groupes de diagnostic.
Conclusions
Les complications cardiaques sont fréquentes chez les patients atteints d’une cardiopathie
congénitale. À l’exception de l’AVC périopératoire et du bloc cardiaque complet, les
TI sont peu élevés pendant l’enfance, mais augmentent au cours de la vie adulte. Ces
données mettent en lumière l’importance du suivi tout au long de la vie et pourraient
contribuer à améliorer l’affectation des ressources permettant un tel suivi.
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Article info
Publication history
Published online: September 28, 2018
Accepted:
September 19,
2018
Received:
June 20,
2018
Footnotes
See page 1629 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
