Right atrial dysfunction is associated with atrial arrhythmias in adults with repaired tetralogy of fallot
Abstract
Background Adults with repaired tetralogy of Fallot (TOF) have right atrial (RA) remodeling and dysfunction, and RA function can be measured using speckle tracking echocardiography. There are limited data about the role of RA strain imaging for risk stratification in this population. We hypothesized that RA reservoir strain can identify TOF patients at risk of developing atrial arrhythmia. To test this hypothesis, we assessed the relationship between RA reservoir strain and atrial arrhythmias in adults with repaired TOF. Method Retrospective cohort study of adults with repaired TOF, and no prior history of atrial arrhythmias. Atrial arrhythmia was defined as atrial fibrillation, atrial flutter/atrial tachycardia, and categorized as new-onset versus recurrent atrial arrhythmias. Results We identified 426 patients (age 33 ± 12 years; males 208 (49%)) that met the inclusion criteria. The mean RA reservoir strain, conduit strain, and booster strain were 34 ± 11%, 20 ± 9%, and 15 ± 12%, respectively. Of 426 patients, 73 (17%) developed new-onset atrial arrhythmias (atrial flutter/tachycardia n = 42; atrial fibrillation n = 31); annual incidence 1.9%. RA reservoir strain was associated with new-onset atrial arrhythmias (adjusted HR 0.95, 95% CI 0.93-0.97) after multivariable adjustment. Of 73 patients with new-onset atrial arrhythmia, 41 (56%) had recurrent atrial arrhythmia (atrial flutter/tachycardia n = 18; atrial fibrillation n = 23); annual incidence 11.2%. Similarly, RA reservoir strain was associated with recurrent atrial arrhythmias (adjusted HR 0.92, 95% CI 0.88-0.96) after multivariable adjustment. Conclusions RA strain indices can identify patients at risk for atrial arrhythmias, and this can in turn, be used to guide the type/intensity of therapy in such patients.
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Different studies have observed that the mechanics of both the left atrium and right atrium are impaired in the TOF population.
“Finally, different studies have observed that the mechanics of both the left atrium (LA) and right atrium (RA) are impaired in this population [22,23,24].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [22]
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- Authors
- Egbe, A. C., Miranda, W. R., Madhavan, M., Abozied, O., Younis, A. K., Ahmed, M. H., Connolly, H. M., & Deshmukh, A. J.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Egbe, Alexander C.
- ORCID
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2023-09
- Volume
- 263
- Pages
- 141-150
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W4379115076
- Cited by
- 8
- References
- 27
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 1
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Update notices
- erratum (2024-09-01)
- Open access
- closed
- Licence
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01 HL158517, R01 HL160761)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- repaired tetralogy of Fallot, atrial arrhythmias, atrial fibrillation, atrial flutter, atrial tachycardia, right atrial reservoir strain, speckle tracking echocardiography, right atrial remodeling, risk stratification, adult congenital heart disease
- MeSH terms
- Adult, Atrial Fibrillation, Atrial Flutter, Humans, Male, Middle Aged, Retrospective Studies, Tachycardia, Tachycardia, Supraventricular, Tetralogy of Fallot, Young Adult
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