title: Atrial arrhythmia after transcatheter closure of secundum atrial septal defects in patients ≥40 years of age.
abstract: OBJECTIVE
  Data on arrhythmia outcome following device closure of atrial septal defect (ASD) are lacking. This study provides medium-term follow-up data on atrial arrhythmias in patients who were ≥40 years of age at the time of transcatheter ASD closure.
  
  
  RESULTS
  It is a retrospective review. Mean age of the 159 patients was 57 years. Median follow-up was 3.6 years (range 6 months-10.9 years). Patients were classified, according to arrhythmia status prior to ASD closure, into Group I, no history of atrial arrhythmia (n = 119, mean age 55.5 years); Group II, paroxysmal atrial arrhythmia (n = 18, mean age 55.7 years); and Group III, persistent atrial fibrillation (n = 22, mean age 65.7 years). Group III patients were significantly older, had larger left atrial size, and had higher mean pulmonary arterial pressure than Group I and II patients (P < 0.001). Prior to closure, radiofrequency ablation was carried out in 12/18 (66%) of Group II and 3/22 (14%) of Group III. After device closure, 7 patients (6%) of Group I developed new atrial fibrillation. Fifty per cent (9/18) of Group II but only 9% (2/22) of Group III were in sinus rhythm on follow-up.
  
  
  CONCLUSIONS
  Device closure alone in patients with persistent atrial arrhythmia is not likely to restore sinus rhythm in the medium term. New atrial arrhythmia occurred in 6% of patients who were in sinus rhythm prior to device closure. At least 50% of the patients with paroxysmal atrial arrhythmia continue to have significant atrial arrhythmia following device closure, and the role of ablation prior to closure in patients with a history of arrhythmia requires refinement.
authors.affiliation: Department of Congenital Heart Disease, Congenital Heart Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK.
authors.forename: Phuoc
authors.initials: P
authors.lastname: Duong
authors.affiliation: Department of Congenital Heart Disease, Congenital Heart Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK.
authors.forename: Lee Patrick
authors.initials: LP
authors.lastname: Ferguson
authors.affiliation: Department of Congenital Heart Disease, Congenital Heart Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lord
authors.affiliation: Department of Congenital Heart Disease, Congenital Heart Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Murray
authors.affiliation: Department of Congenital Heart Disease, Congenital Heart Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK.
authors.forename: Ewen
authors.initials: E
authors.lastname: Shepherd
authors.affiliation: Department of Congenital Heart Disease, Congenital Heart Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK.
authors.forename: John Pius
authors.initials: JP
authors.lastname: Bourke
authors.affiliation: Department of Congenital Heart Disease, Congenital Heart Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK.
authors.forename: David
authors.initials: D
authors.lastname: Crossland
authors.affiliation: Department of Congenital Heart Disease, Congenital Heart Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK.
authors.forename: John
authors.initials: J
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D006328:Cardiac Catheterization / Q000009:adverse effects*; D017115:Catheter Ablation; D018572:Disease-Free Survival; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial arrhythmia; Atrial septal defect; Device closure; Radiofrequency ablation