Long-Term Risk of Atrial Fibrillation and Stroke in Patients With Atrial Septal Defect Diagnosed in Childhood
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Long-Term Risk of Atrial Fibrillation and Stroke in Patients With Atrial Septal Defect Diagnosed in Childhood. / Karunanithi, Zarmiga; Nyboe, Camilla; Hjortdal, Vibeke Elisabeth.
I: The American Journal of Cardiology, Bind 119, Nr. 3, 01.02.2017, s. 461-465.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Long-Term Risk of Atrial Fibrillation and Stroke in Patients With Atrial Septal Defect Diagnosed in Childhood
AU - Karunanithi, Zarmiga
AU - Nyboe, Camilla
AU - Hjortdal, Vibeke Elisabeth
N1 - Copyright © 2016 Elsevier Inc. All rights reserved.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - The aim of this study was to evaluate the long-term risk of atrial fibrillation (AF) and stroke in patients with atrial septal defect (ASD) diagnosed before the age of 18 years. Patients diagnosed with ASD from 1963 to 2011 were identified through national Danish registers, of which 1,111 fulfilled the inclusion criteria. Each patient was matched with 10 control subjects on age and gender. Risk of AF and stroke was assessed using Cox proportional hazards regression. Cumulative incidences were calculated using Fine and Gray competing risk regression. Median follow-up time was 24 years (range 1 to 49 years). Patients with ASD had a significantly increased risk of AF; both with closure (adjusted hazard ratio [HR] 18.5, 95% confidence interval [CI] 7.8 to 44.1, p <0.0001) and without closure (HR 16.4, 95% CI 6.8 to 39.8, p <0.0001) were compared with control subjects. A comparison of surgical closure with transcatheter closure showed no difference in risk of AF (HR 1.1, 95% CI 0.3 to 4.8, p = 0.864). Risk of stroke was increased in patients with ASD closure (adjusted HR 5.0, 95% CI 2.3 to 11.1, p <0.0001) compared to the control subjects. The use of anticoagulants was increased in patients with ASD regardless of closure (adjusted HR 7.7, 95% CI 4.9 to 12.1, p <0.0001 with closure and HR 4.0, 95% CI 1.9 to 8.7, p <0.0001 without closure). Usage of antiarrhythmic drugs was significantly increased in patients with ASD with closure (adjusted HR 14.8, 95% CI 7.2 to 30.2, p <0.0001). In conclusion, patients diagnosed with an ASD before the age of 18 years had an increased risk of AF in adulthood compared to controls. The risk of AF and stroke was increased despite closure in childhood, and method of closure did not affect the risk of developing AF later in life.
AB - The aim of this study was to evaluate the long-term risk of atrial fibrillation (AF) and stroke in patients with atrial septal defect (ASD) diagnosed before the age of 18 years. Patients diagnosed with ASD from 1963 to 2011 were identified through national Danish registers, of which 1,111 fulfilled the inclusion criteria. Each patient was matched with 10 control subjects on age and gender. Risk of AF and stroke was assessed using Cox proportional hazards regression. Cumulative incidences were calculated using Fine and Gray competing risk regression. Median follow-up time was 24 years (range 1 to 49 years). Patients with ASD had a significantly increased risk of AF; both with closure (adjusted hazard ratio [HR] 18.5, 95% confidence interval [CI] 7.8 to 44.1, p <0.0001) and without closure (HR 16.4, 95% CI 6.8 to 39.8, p <0.0001) were compared with control subjects. A comparison of surgical closure with transcatheter closure showed no difference in risk of AF (HR 1.1, 95% CI 0.3 to 4.8, p = 0.864). Risk of stroke was increased in patients with ASD closure (adjusted HR 5.0, 95% CI 2.3 to 11.1, p <0.0001) compared to the control subjects. The use of anticoagulants was increased in patients with ASD regardless of closure (adjusted HR 7.7, 95% CI 4.9 to 12.1, p <0.0001 with closure and HR 4.0, 95% CI 1.9 to 8.7, p <0.0001 without closure). Usage of antiarrhythmic drugs was significantly increased in patients with ASD with closure (adjusted HR 14.8, 95% CI 7.2 to 30.2, p <0.0001). In conclusion, patients diagnosed with an ASD before the age of 18 years had an increased risk of AF in adulthood compared to controls. The risk of AF and stroke was increased despite closure in childhood, and method of closure did not affect the risk of developing AF later in life.
KW - Adolescent
KW - Adult
KW - Anti-Arrhythmia Agents/therapeutic use
KW - Anticoagulants/therapeutic use
KW - Atrial Fibrillation/epidemiology
KW - Child
KW - Child, Preschool
KW - Denmark/epidemiology
KW - Female
KW - Heart Septal Defects, Atrial/epidemiology
KW - Humans
KW - Incidence
KW - Longitudinal Studies
KW - Male
KW - Middle Aged
KW - Proportional Hazards Models
KW - Registries
KW - Risk Factors
KW - Stroke/epidemiology
KW - Young Adult
U2 - 10.1016/j.amjcard.2016.10.015
DO - 10.1016/j.amjcard.2016.10.015
M3 - Journal article
C2 - 27939228
VL - 119
SP - 461
EP - 465
JO - Am. J. Cardiol.
JF - Am. J. Cardiol.
SN - 0002-9149
IS - 3
ER -
ID: 241830015