title: 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: Division of Cardiology, Department of Medicine Grown-Up Congenital Heart Disease Clinic, Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Kyoung-Min
authors: KM
authors: Park
authors: Jin Kyung
authors: JK
authors: Hwang
authors: Kwang Jin
authors: KJ
authors: Chun
authors: Seung-Jung
authors: SJ
authors: Park
authors: Young Keun
authors: YK
authors: On
authors: June Soo
authors: JS
authors: Kim
authors: Seung Woo
authors: SW
authors: Park
authors: I-Seok
authors: IS
authors: Kang
authors: Jinyoung
authors: J
authors: Song
authors: June
authors: J
authors: Huh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013610:Tachycardia / Q000000981:diagnostic imaging / Q000209:etiology*; D013997:Time Factors; D055815:Young Adult