Department of Molecular and Clinical Medicine/Cardiology Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden.
Department of Medicine Region Västra Götaland, Sahlgrenska University Hospital/Östra, Geriatrics and Emergency Medicine/Östra Gothenburg Sweden.
J Am Heart Assoc. 2024 Sep 3;13(17):e032813. doi: 10.1161/JAHA.123.032813. Epub 2024 Aug 27.
Atrial fibrillation (AF) is a common arrhythmia in patients with congenital heart disease (CHD), but little is known about the risk for ischemic stroke among younger patients with CHD (aged <65 years) with AF.
Using data from the National Swedish Patient Register and Cause of Death Register, we identified all patients with both CHD and AF born in Sweden between 1970 and 2017. The Swedish total population register was used to identify age- and sex-matched patients without CHD; those with AF were used as controls. Bottos hierarchical classification was used to define CHD as either complex or noncomplex. Controls were followed from the onset of AF until the index ischemic stroke, death, or end of study (December 31, 2017). We identified 951 patients with CHD with AF and 606 controls with AF. Among patients with both CHD and AF, 2.9% of patients (n=28) developed ischemic stroke, compared with 0.5% (n=3) in controls. When adjusted for age, sex, hypertension, and heart failure, a hazard ratio (HR) of 5.16 (95% CI, 1.52-17.46) was acquired. The HR in noncomplex CHD was 3.84 (95% CI, 1.07-13.84), and the HR in complex CHD was 8.34 (95% CI, 2.27-30.57). For patients born in 1970 to 1989, the HR in ischemic stroke was 7.35 (95% CI, 1.70-31.75). No adjusted HR for patients with CHD born in 1990 to 2017 could be acquired due to few events.
The risk for ischemic stroke may be 5 times higher in patients with both CHD and AF compared with patients without CHD with AF. However, larger studies may be needed to confirm/refute these results.
心房颤动（AF）是先天性心脏病（CHD）患者常见的心律失常，但对于年龄<65 岁的 CHD 合并 AF 的年轻患者发生缺血性卒中的风险知之甚少。
利用来自瑞典国家患者登记处和死因登记处的数据，我们确定了 1970 年至 2017 年期间所有在瑞典出生的 CHD 合并 AF 的患者。使用瑞典总人口登记处来确定年龄和性别匹配的无 CHD 患者；这些患者的 AF 作为对照。采用 Bottos 分层分类法将 CHD 定义为复杂或非复杂。对照者从 AF 发病开始随访至缺血性卒中、死亡或研究结束（2017 年 12 月 31 日）。我们确定了 951 例 CHD 合并 AF 的患者和 606 例 AF 对照者。在合并 CHD 和 AF 的患者中，有 2.9%（n=28）发生了缺血性卒中，而对照组为 0.5%（n=3）。在校正年龄、性别、高血压和心力衰竭后，获得了 5.16（95%可信区间，1.52-17.46）的危险比（HR）。非复杂 CHD 的 HR 为 3.84（95%可信区间，1.07-13.84），复杂 CHD 的 HR 为 8.34（95%可信区间，2.27-30.57）。对于 1970 年至 1989 年出生的患者，缺血性卒中的 HR 为 7.35（95%可信区间，1.70-31.75）。由于事件较少，无法获得 1990 年至 2017 年出生的 CHD 患者的校正 HR。
与无 CHD 的 AF 患者相比，合并 CHD 和 AF 的患者发生缺血性卒中的风险可能高出 5 倍。但是，可能需要更大的研究来证实/反驳这些结果。
