Utility of Cardiac Magnetic Resonance Imaging in Predicting Atrial Arrhythmias in Repaired Tetralogy of Fallot

Arrhythmias are the leading cause of morbidity and mortality in repaired tetralogy of Fallot (TOF), and over 20% of these patients will develop a sustained atrial arrhythmia during their lifetimes. Cardiac magnetic resonance imaging (cMRI) is frequently performed in TOF, although its ability to iden...

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Bibliographic Details
Published in:The American journal of cardiology 2022-07, Vol.174, p.151-157
Main Authors: Pinsker, Bret L., Serfas, John D., Awerbach, Jordan D., Dizon, Samantha, Spector, Zebulon Z., Campbell, Michael J., Krasuski, Richard A.
Format: Article
Language:English
Subjects:
Age
Arrhythmia
Automation
Cardiac arrhythmia
Cardiovascular disease
Confidence intervals
Congenital diseases
Coronary vessels
Diabetes
Diabetes mellitus
Ejection fraction
Electrocardiography
Heart
Hypertension
Magnetic resonance imaging
Morbidity
Patients
Regurgitation
Resonance
Statistical analysis
Tetralogy of Fallot
Vein & artery diseases
Velocity
Ventricle
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Summary:Arrhythmias are the leading cause of morbidity and mortality in repaired tetralogy of Fallot (TOF), and over 20% of these patients will develop a sustained atrial arrhythmia during their lifetimes. Cardiac magnetic resonance imaging (cMRI) is frequently performed in TOF, although its ability to identify patients at risk of atrial arrhythmias is uncertain. Adult TOF patients (n = 175) with no history of atrial arrhythmia who underwent cMRI between 2003 and 2020 at a single tertiary care center were identified. Clinical characteristics and imaging findings were evaluated to identify a predilection for atrial arrhythmias using Kaplan–Meier survival analysis and log-rank testing. Multivariable Cox regression was used to determine independent predictors of atrial arrhythmias. Over a median follow-up of 3.6 years, 29 patients (17%) developed atrial arrhythmias. Independent predictors of atrial arrhythmia included age (hazard ratio [HR] 1.06 per 1-year increase, 95% confidence interval [CI] 1.02 to 1.09, p = 0.002), diabetes mellitus (HR 4.26, 95% CI 1.26 to 14.41, p = 0.020), indexed right ventricular end-diastolic volume (RVEDVi), (HR 1.20 per 10-ml/m2 increase, 95% CI 1.05 to 1.39, p = 0.010), and moderate or greater tricuspid regurgitation (TR) (HR 6.32, 95% CI 2.15 to 18.60, p = 0.001). Utilizing Kaplan–Meier analysis, patients with at least mild right ventricular dilation (RVEDVi >100 ml/m2, p = 0.047) and greater than or equal to moderate TR (p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2022.03.043