ESC Congress edition:2010 location:Stockholm, Sweden date:28 August - 01 September 2010
Aims: Atrial fibrillation and flutter remain an important cause of morbidity in adults with atrial septal defect (ASD). This study aimed to investigate predictors for late (≥1 month after repair) atrial arrhythmia.
Methods: Patients with ASD type secundum, older than 18 years, were selected through the databases of three medical centres in Belgium and were stratified into a surgical and transcatheter treated group. Preprocedural, periprocedural and follow-up data were extracted. Analyzed variables were entered into univariate and multivariate Cox regression analysis. Receiver-operating characteristic (ROC) analysis was performed for any independent predictor of late atrial arrhythmia.
Results: A total of 296 patients (87 men, 209 women) was included. One hundred and fourteen patients (median age 25.8 years, range 18.5–79.4 years) underwent surgical and 167 (median age 57.4 years, range 18.4–88.1 years) underwent transcatheter ASD closure. Only age at repair predicted late atrial arrhythmia in surgically treated patients (HR 1.07; 95% CI, 1.02–1.12; P=0.009). However, only mean pulmonary artery pressure (mPAP) independently predicted late atrial arrhythmia in percutaneously treated patients (HR 1.09; 95% CI, 1.00–1.20; P=0.049). According to ROC analysis, mPAP ≥22.5 mmHg had a sensitivity of 80% and specificity of 81.7% for predicting late atrial arrhythmia (AUC 0.835; 95% CI, 0.726–0.944).
Conclusion: Age at repair was the main predictor of late atrial arrhythmia in surgically closed ASD patients. However, only mPAP independently predicted late atrial arrhythmia after transcatheter ASD closure. A mPAP ≥22.5 mmHg predicted late atrial atrial with a sensitivity and specificity of 80% and 81.7% and should raise increased awareness for atrial arrhythmias and may be used to guide therapy.