AHA Scientific Sessions 2010 edition:2010 location:Chicago, US date:16 - 20 November 2010
Aims: Atrial fibrillation and flutter remain an important cause of morbidity in adults with atrial septal defect (ASD). This study aimed at investigating predictors of late (≥1 month after repair) atrial arrhythmia.
Methods: Patients who underwent ASD closure after the age of 18 years were selected through the databases of three medical centres in Belgium. Preprocedural, periprocedural and follow-up data were extracted. Uni- and multivariate Cox-regression analysis was performed. Kaplan-meier analysis was performed for any independent predictor of late atrial arrhythmia.
Results: A total of 155 patients (38 men, 117 women) was included. Twenty-four patients (median age 48.3 years, range 19.9–79.8) underwent surgical and 131 (median age 57.6 years, range 18.2–86.9) transcatheter closure. Thirty-nine patients (25.2%) presented with late atrial arrhythmia. Gender (P=0.008), creatinine (P=0.002), atrial arrhythmia before (P<0.0001) and ≤1 month after repair (P=0.001) and mean pulmonary artery pressure (mPAP) ≥25mmHg (P<0.0001) correlated with late atrial arrhythmia in univariate Cox-regression analysis. Multivariate analysis showed that a mPAP ≥25mmHg (HR 3.73; 95%CI 1.83-7.61; P<0.0001), the presence of atrial arrhythmia before (HR 3.18; 95%CI 1.54-6.57; P=0.002) and ≤1 month after repair (HR 5.77; 95%CI 2.08-15.98; P=0.001) were predictive of late atrial arrhythmia. Kaplan-Meier analysis showed that patients with a mPAP ≥25mmHg had a higher risk at developing late atrial arrhythmia (P<0.0001).
Conclusion: In patients with ASD type secundum, the risk for late atrial arrhythmia is related to mPAP. The presence of pulmonary hypertension before ASD closure should raise awareness for atrial arrhythmias and may be used to guide therapy.