BackgroundA significant percentage of patients with congenital heart disease surviving into adulthood will develop arrhythmias. These arrhythmias are associated with an increased risk of adverse events and death. We aimed to assess arrhythmia prevalence, risk factors, and associated health care usage in a large national cohort of patients with adult congenital heart disease.Methods and ResultsAdults with a documented diagnosis of congenital heart disease, insured by Clalit and Maccabi health services between January 2007 and December 2011, were included. We assessed the associations between arrhythmia and subsequent hospitalization rates and death with mixed negative binomial and Cox proportional hazard models, respectively. Among 11 653 patients with adult congenital heart disease (median age, 47 years [interquartile range, 31–62]), 8.7% had a tachyarrhythmia at baseline, 1.5% had a conduction disturbance, and 0.5% had both. Among those without a baseline arrhythmia, 9.2% developed tachyarrhythmias, 0.9% developed a conduction disturbance, and 0.3% developed both during the study period. Compared with no arrhythmia (reference group), arrhythmia in the previous 6 months was associated with a higher multivariable adjusted hospitalization rate, 1.33‐fold higher than the rate of the reference group (95% CI, 1.00–1.76) for ventricular arrhythmia, 1.27‐fold higher (95% CI, 1.17–1.38) for atrial arrhythmias, and 1.33‐fold higher (95% CI, 1.04–1.71) for atrioventricular block. Atrial tachyarrhythmias were associated with an adjusted mortality hazard ratio (HR) of 1.65 (95% CI, 1.44–2.94), and ventricular tachyarrhythmias with a >2‐fold increase in mortality risk (HR, 2.06 [95% CI, 1.44–2.94]).ConclusionsArrhythmias are significant comorbidities in the adult congenital heart disease population and have a significant impact on health care usage and survival.

中文翻译：

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成人先天性心脏病患者的心律失常负担：一项基于人群的研究

背景很大比例的先天性心脏病患者在成年后会出现心律失常。这些心律失常与不良事件和死亡风险增加有关。我们的目的是评估全国成人先天性心脏病患者的心律失常患病率、危险因素和相关医疗保健使用情况。方法和结果有先天性心脏病诊断记录、2007 年 1 月期间由 Clalit 和 Maccabi 医疗服务承保的成人和2011年12月，都被包括在内。我们分别使用混合负二项式和 Cox 比例风险模型评估了心律失常与随后的住院率和死亡率之间的关联。在 11 653 名成人先天性心脏病患者中（中位年龄 47 岁[四分位距，31-62]），8.7% 的患者在基线时患有快速心律失常，1.5% 的患者患有传导障碍，0.5% 的患者同时患有这两种疾病。在基线没有心律失常的患者中，9.2% 的人出现快速心律失常，0.9% 的人出现传导障碍，0.3% 的人在研究期间出现这两种情况。与无心律失常（参考组）相比，前 6 个月的心律失常与较高的多变量调整住院率相关，是室性心律失常参考组（95% CI，1.00-1.76）住院率的 1.33 倍，1.27房性心律失常高出 1 倍（95% CI，1.17-1.38），房室传导阻滞高出 1.33 倍（95% CI，1.04-1.71）。房性快速心律失常与调整后的死亡风险比 (HR) 1.65 (95% CI, 1.44–2.94) 相关，室性快速心律失常的死亡风险增加 2 倍以上 (HR, 2.06 [95% CI, 1.44–2.94) ]).结论心律失常是成人先天性心脏病人群的重要合并症，对医疗保健的使用和生存有重大影响。