title: Pathophysiology and Management of Arrhythmias Associated with Atrial Septal Defect and Patent Foramen Ovale.
abstract: Atrial septal defects (ASDs) are among the most common of congenital heart defects and are frequently associated with atrial arrhythmias. Atrial and ventricular geometrical remodelling secondary to the intracardiac shunt promotes evolution of the electrical substrate, predisposing the patient to atrial fibrillation and other arrhythmias. Closure of an ASD reduces the immediate and long-term prevalence of atrial arrhythmias, but the evidence suggests that patients remain at an increased long-term risk in comparison with the normal population. The closure technique itself and its timing impacts future arrhythmia risk profile while subsequent transseptal access following surgical or device closure is complicated. Newer techniques combined with increased experience will help to alleviate some of the difficulties associated with optimal management of arrhythmias in these patients.
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London; Department of Paediatric Cardiology, Evelina London Children's Hospital.
authors.forename: Henry
authors.initials: H
authors.lastname: Chubb
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London.
authors.forename: John
authors.initials: J
authors.lastname: Whitaker
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London; Adult Congenital Heart Disease Group, Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, UK.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Williams
authors.affiliation: Adult Congenital Heart Disease Group, Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, UK.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Head
authors.affiliation: Adult Congenital Heart Disease Group, Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, UK.
authors.forename: Natali Ay
authors.initials: NA
authors.lastname: Chung
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wright
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London; Adult Congenital Heart Disease Group, Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: O'Neill
keywords: Atrial septal defect; atrial arrhythmias; atrial fibrillation; atrial flutter; device closure; patent foramen ovale; remodelling; transseptal puncture
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