Atrial flutter/fibrillation in patients receiving transcatheter closure of atrial septal defect.
OBJECTIVE
Atrial flutter/fibrillation (AFL/Af) is a common late complication in atrial septal defect (ASD) patients even after occluder implantation. We try to delineate the risk factors of persistent AFL/Af.


METHODS
From 1998 to 2010, all patients older than 18 years of age who received ASD occluder implantation in our hospital were enrolled, and their records were retrospectively reviewed. In addition, renin-angiotensin system gene polymorphisms including angiotensinogen gene, A1166C polymorphism on the angiotensin II type I receptor gene, and insertion/deletion (I/D) patterns on the angiotensin-converting enzyme gene were checked using direct sequencing.


RESULTS
A total of 517 patients (male/female 127/390) were enrolled. The mean age of patients receiving occluder deployment was 41.5 ± 14.5 years. Prior to occluder deployment, 3.9% of patients had persistent Af, 3.1% of patients had paroxysmal Af, and 0.8% had AFL. After a follow-up of 1894 patient-years, 3.5% had persistent Af and 1.9% of patients had paroxysmal Af. The greatest risk factors of AFL/Af genesis included age, occluder size, presence of multiple ASDs, and underlying thyroid or mitral valve disorder (p < 0.001, p < 0.001, p = 0.033, p = 0.016, and p = 0.012, respectively). Preoperative AFL/Af status is the most important factor in determining AFL/Af resolution and progression after an intervention. The renin-angiotensin system gene polymorphisms had no association with AFL/Af genesis, and progression or resolution after intervention.


CONCLUSIONS
AFL/Af is common after ASD occluder implantation, and predisposed by older age, larger and multiple ASDs, and underlying disorders. Preoperative atrial arrhythmia status is the most important predictor of AFL/Af progression or resolution. Renin-angiotensin system gene polymorphisms had no association with AFL/Af.
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
Shuenn-Nan
SN
Chiu
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
Mei-Hwan
MH
Wu
Department of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
Chia-Ti
CT
Tsai
Department of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
Ling-Ping
LP
Lai
Department of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
Jiunn-Lee
JL
Lin
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
Ming-Tai
MT
Lin
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
Chun-Wei
CW
Lu
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan. Electronic address: jkww@ntuh.gov.tw.
Jou-Kou
JK
Wang
D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology*; D001282:Atrial Flutter / Q000209:etiology*; D006328:Cardiac Catheterization; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics; D044139:Receptor, Angiotensin, Type 2 / Q000235:genetics; D055989:Septal Occluder Device
D044139:Receptor, Angiotensin, Type 2; D007703:Peptidyl-Dipeptidase A
atrial flutter/fibrillation; atrial septal defect; gene; renin–angiotensin