Prediction of early-onset atrial tachyarrhythmia after successful trans-catheter device closure of atrial septal defect.

Abstract

Atrial tachyarrhythmia is a well-known long-term complication of atrial septal defect (ASD) in adults, even after successful trans-catheter closure. However, the risk factors for early-onset atrial tachyarrhythmia after trans-catheter closure remain unclear. This retrospective study enrolled adults with secundum ASD undergoing trans-catheter closure from January 2000 to March 2014. We analyzed the clinical characteristics of patients and assessed risk factors for new-onset atrial tachyarrhythmia defined as a composite of atrial fibrillation or flutter (AF/AFL) after ASD closure. We enrolled a total of 427 patients; 123 were male (28.8%) and the median age was 37.0 (interquartile range [IQR]: 18.3-49.0). Nineteen (4.4%) patients had documented atrial tachyarrhythmia during the follow-up period (median: 11.4 months [IQR: 5.4-24]). Patients with transient AF/AFL during closure showed a greater incidence of new-onset atrial tachyarrhythmia during the follow-up period than patients with consistent sinus rhythm during closure (27.3% vs 3.8%; P = 0.01). Most new-onset atrial tachyarrhythmias were documented within 6 months (median: 2.6 [IQR: 1.2-4.1] months) of closure. In the multivariate analysis, the risk for new-onset atrial tachyarrhythmia was significant in patients with AF/AFL during closure (hazard ratio [HR]: 9.90, 95% confidence interval [CI]: 2.86-34.20; P < 0.001), deficient posteroinferior rim (HR: 5.48, 95% CI: 1.15-25.72; P = 0.04), and age of closure over 48 years (HR: 3.30, 95% CI: 1.30-8.38; P = 0.01). In conclusion, transient AF/AFL during trans-catheter closure of ASD as well as deficient posteroinferior rim and age of closure over 48 years may be useful for predicting early new-onset atrial tachyarrhythmia after device closure.

• Authors: Kyoung-Min Park, Jin Kyung Hwang, Kwang Jin Chun, Seung-Jung Park, Young Keun On, June Soo Kim, Seung Woo Park, I-Seok Kang, Jinyoung Song, June Huh
• Journal: Medicine (Medicine (Baltimore)) Vol. 95 Issue 35 Pg. e4706 (Aug 2016) ISSN: 1536-5964 [Electronic] United States
• PMID: 27583905 (Publication Type: Journal Article, Observational Study)

Topics

• Adolescent
• Adult
• Age Factors
• Cardiac Catheterization (adverse effects)
• Echocardiography, Transesophageal
• Electrocardiography
• Heart Septal Defects, Atrial (diagnostic imaging, physiopathology, surgery)
• Hemodynamics
• Humans
• Male
• Middle Aged
• Postoperative Complications
• Retrospective Studies
• Risk Factors
• Tachycardia (diagnostic imaging, etiology)
• Time Factors
• Young Adult