title: Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure.
abstract: OBJECTIVE
  To estimate the risk of atrial fibrillation (AF) and stroke and the impact of closure in patients with atrial septal defect (ASD) compared with a general population cohort.
  
  
  METHODS
  All adult Danish patients (>18 years) diagnosed with ASD from 1977 to 2009 (N=1168) were identified through population-based registries. Using Cox regression, we compared ASD patients' risk of AF and stroke with an age-matched and gender-matched comparison cohort. We computed prevalence proportions of anticoagulation and antiarrhythmic medicine use before and after closure and described stroke-related mortality.
  
  
  RESULTS
  Median follow-up was 9.6 years (range 1-33 years). Patients with ASD had a higher risk of first-time AF (adjusted HR 8.2; 95% CI 6.6 to 10.2) after closure than the comparison cohort, but with no difference between transcatheter and surgical closure (HR 1.5, 95% CI 0.6 to 3.5). Patients without prevalent AF had a 10-year cumulative incidence of AF of 11% (95% CI 9% to 14%) after closure compared with 2% (95% CI 1.8% to 2.5%) in the comparison cohort. Patients with ASD with prevalent AF continued to use anticoagulation medicine after closure/diagnosis. Patients with ASD had increased risk of stroke without closure (adjusted HR 2.6; 95% CI 1.4 to 3.0) and with closure (adjusted HR 2.0; 95% CI 1.4 to 2.7). Risk of stroke after closure was related to AF (HR adjusted for AF 1.3; 95% CI 0.9 to 1.9).
  
  
  CONCLUSIONS
  Patients with ASD had a higher risk of first-time AF after closure than the comparison cohort. There was no effect of closure on the use of AF-related medicine in patients with prevalent AF.
authors.affiliation: Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Nyboe
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: M S
authors.initials: MS
authors.lastname: Olsen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: J E
authors.initials: JE
authors.lastname: Nielsen-Kudsk
authors.affiliation: Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: V E
authors.initials: VE
authors.lastname: Hjortdal
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants
keywords: CONGENITAL HEART DISEASE