Predicting the Occurrence of Atrial Arrhythmia After Closure of an Atrial Septal Defect (original) (raw)
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Predictive model for late atrial arrhythmia after closure of an atrial septal defect
International Journal of Cardiology, 2013
Objectives: To develop a quantitative event-free prediction model of late atrial arrhythmia after atrial septal defect (ASD) repair. Background: The clinical management of ASD is driven by risk factors that determine the occurrence of late atrial arrhythmia. Methods: Data from ASD type secundum patients, included in the Belgian Congenital Heart Disease Registry, were analyzed. Based on review of the literature, age at repair, gender, pulmonary hypertension, atrial arrhythmia before and within one month after repair were included in the model. Using Cox-regression analysis, a weighted risk score was derived, which was validated using the Brier score. Results: A total of 155 patients (117 women; median age at follow-up 53.9 years, range 18.0-78.8) having 349 follow-up years was included. Thirty-nine patients (25.2%) presented with late atrial arrhythmia. Multivariate analysis showed that a mPAP ≥ 25 mmHg (HR 4.39; 95%CI 2.17-9.09; P b 0.0001), the presence of atrial arrhythmia before (HR 3.52; 95%CI 1.75-7.14; P = 0.002) and ≤ 1 month after repair (HR 6.62; 95%CI 2.38-20.00; P b 0.0001) and gender (HR 2.18 95%CI 1.11-4.35) were associated with late atrial arrhythmia. A risk score (0 to 28 points) to predict atrial arrhythmia free survival was derived for follow-up times ranging from one to 5 years. Mean Brier score for the model was 0.10. Conclusions: We formulated a well validated risk model to predict arrhythmia-free survival in ASD patients undergoing ASD repair. Further research is needed whether this model can be used for individual clinical risk stratification and whether the model can be adapted for application in other congenital heart defects.
Prognostic Significance of Atrial Arrhythmias in a Primary Prevention ICD Population
Pacing and Clinical Electrophysiology, 2011
Introduction: We investigated whether primary prevention implantable cardioverter defibrillator (ICD) patients with atrial arrhythmias are at higher risk for ICD shocks and mortality compared to patients without atrial arrhythmias in a subanalysis of the PREPARE study. Methods and Results: Details of the PREPARE study design and results have been previously reported. We now included 537 of the 700 patients enrolled in PREPARE. These patients had a dual or biventricular device and at least one device follow-up after implantation. Continuously collected device diagnostics data were used to classify patients into two groups during follow-up: with (n = 133) or without (n = 404) atrial tachycardia/atrial fibrillation (AT/AF). The primary outcomes were ICD shocks and mortality. Subjects were followed for a mean of 333 ± 73 (range 5-365) days. During a follow-up of 1 year, ICD shocks occurred in 44 (8%) patients. Significantly, more patients with AT/AF received a shock (13.0% vs 6.9%, P = 0.03), with inappropriate shocks accounting for the majority of the difference (6.9% vs 2.6%, P = 0.02). There was no difference in prevalence of shocks between patients with and without a history of AF. Mortality was similar in patients with and without AT/AF, whether detected during the study or prior to the study. In addition, the 34 subjects with high average ventricular rate (≥110 beats per minute) during AT/AF had a higher risk of an inappropriate shock (21.0% vs 2.1%, P < 0.01). Conclusion: Primary prevention ICD patients with AT/AF are more likely to receive shocks, especially inappropriate shocks. Mortality was not higher in AT/AF patients.
International Journal of Cardiology, 2011
Aims: Atrial fibrillation and flutter remain an important cause of morbidity in adults with atrial septal defect (ASD). This study aimed at investigating predictors for late (≥1 month after repair) atrial arrhythmia. Methods: Patients who underwent ASD closure after the age of 18 years, were selected through the databases of three medical centres in Belgium. Preprocedural, periprocedural and follow-up data were extracted. Univariate and multivariate Cox-regression analysis was performed. Kaplan-Meier analysis was performed for any independent predictor of late atrial arrhythmia. Results: A total of 155 patients (38 men and 117 women) was included. Twenty-four patients (median age 48.3 years, range 19.9-79.8) underwent surgical and 131 (median age 57.6 years, range 18.2-86.9) underwent transcatheter closure. Thirty-nine patients (25.2%) presented with late atrial arrhythmia. Male gender (P= 0.008), creatinine (P= 0.002), atrial arrhythmia before (Pb 0.0001) and within 1 month after repair (P= 0.001) and a mean pulmonary artery pressure (mPAP) ≥25 mm Hg (Pb 0.0001) correlated with late atrial arrhythmia in univariate Cox-regression analysis. Multivariate analysis showed that mPAP ≥25 mm Hg (HR 3.72; 95%CI 1.82-7.59; P b 0.0001) and the presence of atrial arrhythmia before (HR 3.22; 95%CI 1.56-6.66; P = 0.002) and within 1 month after repair (HR 2.08; 95%CI 2.08-15.92; P = 0.001) were predictive of late atrial arrhythmia. Kaplan-Meier analysis showed that patients with a mPAP ≥25 mm Hg had a higher risk at developing late atrial arrhythmia (Pb 0.0001). Conclusion: In patients with ASD type secundum, a mPAP ≥25 mm Hg is an independent predictor of late atrial arrhythmia. The presence of pulmonary hypertension before repair should raise awareness for atrial arrhythmias and may be used to guide therapy.
Risk factors for prolonged intensive care treatment following atrial septal defect closure in adults
2008
Background: Today, percutaneous or surgical closure of atrial septal defects (ASD) in adults are considered effective and safe treatments. However, some cases of severe left ventricular dysfunction after ASD closure were observed. This study aims at identifying predictors for prolonged intensive care unit stay, and postoperative inotropic support after ASD closure. Methods: Records of 281 adult patients who had undergone surgical closure of a secundum ASD between 1974 and 2000 at an age over 30 years (mean 43.8, maximum 76 years) were reviewed retrospectively. The endpoints were defined as prolonged intensive care unit stay (> 2 days), and postoperative inotropic support (Dopamine, Dobutamine or Adrenalin). Results: Thirty-day mortality rate was 0.7% (2 patients). Prolonged intensive care unit stay was observed in 70 patients (25%). Postoperative inotropic support was necessary in 84 patients (30%). Independent risk factors for prolonged intensive care unit stay in multivariate analysis were preoperative atrial fibrillation (p = 0.011), and larger ASD (p = 0.026). Older age at operation (p < 0.001) and longer time on extracorporeal circulation (p < 0.001) emerged as independent risk factor for postoperative use of inotropic support in multivariate analysis. Conclusions: Surgical ASD closure in adults is usually safe. However, a distinct subgroup of patients is at risk for prolonged intensive care treatment. Timely closure of the ASD must be advised since older age emerged as a predictor for postoperative use of inotropic support. Since atrial fibrillation is a strong independent risk factor for prolonged intensive care unit stay the preservation of sinus rhythm must be aimed at.
Journal of Ayub Medical College, Abbottabad : JAMC
Device closure of Secundum atrial septal defect (ASD) is an accepted mode of treatment in selected patients with a suitable defect. The major initial concern over the long-term outcome has been erosions and more recently development of aortic regurgitation. Objective was to assess the intermediate and long term outcome of patients with device closure of ASD with special reference to complications. Two hundred and four patients with significant Secundum ASD, 16 months to 55 years (median 8 years) were considered for transcatheter closure with the Amplatzer septal occluder from October 1999 to April 2009 with follow up examinations at 1, 3, 6, and 12 months and thereafter at yearly interval. Device closure of ASD was done successfully in 202/204 patients. The immediate (first 24-hour) major complications included device embolization (n = 4), pericardial effusion (n = 1) and 2:1 heart block (n = 1). At a mean follow up of 4.9 years (90 days to 9.6 years, median 5.3 years) complete clos...
Heart Rhythm, 2018
Background: Atrial fibrillation (AF) and other supraventricular tachycardias (SVT) are known complications after surgical repair of an atrial septal defect (ASD), but sinus node dysfunction (SND) and complete atrioventricular conduction block (cAVB) may also occur. Objective: The aims of this study were to examine time course and interrelationship of various dysrhythmias in patients with an ASD. Methods: Adult patients (N=95) with a surgically repaired secundum ASD (N=40), partial atrioventricular septal defect (N=37) or sinus venosus defect (N=18) and documented SND, cAVB, AF and/or other SVT were included. Median age at repair was 13 years (interquartile range 6-45) and patients were followed for 26 years (interquartile range 15-37) after ASD repair. Results: SND was observed in 34 patients (36%), cAVB in 14 (14%), AF in 48 (49%) and SVT in 44 (45%); 37 (39%) patients had ≥2 dysrhythmias. All dysrhythmias presented most often after ASD repair (p<0.01) with a median duration of 12 to 16 years between repair and onset. Development of SND and cAVB late after ASD repair was not related to a redo procedure in respectively 100% and 60% of patients. SND preceded atrial tachyarrhythmias in 50% (p=0.31) and SVT preceded AF in 68% (p=0.09) of patients with both dysrhythmias. Conclusions: A substantial number of dysrhythmias presented (very) late after ASD repair. In most patients, development of late SND and cAVB was not related to redo procedures. In patients with multiple dysrhythmias, a specific order of appearance was not observed.
The American Journal of Cardiology, 2012
Truly long-term follow-up data after transcatheter closure (TC) of atrial septal defects (ASDs) are scarce. We report the 5-to 20-year outcomes of TC and surgical closure (SC) for typical secundum ASD. We reviewed the records of patients with isolated secundum ASD and right ventricular volume overload who underwent TC or SC (January 1, 1986 to September 30, 2005). Follow-up was obtained through a combination of chart review, physician records, and telephone survey. We identified 375 patients (207 SC and 168 TC) and obtained follow-up data >5 years (median follow-up 10 years) for 300 (152 SC, 148 TC). Nine patients have died (3%). The New York Heart Association functional class was unchanged in 227 patients, improved in 25, and was worse in 15. Clinically significant arrhythmia was found in 28 patients (9.3%); 21% aged >40 years developed arrhythmia. On multivariate analysis, the odds of significant arrhythmia tended to be greater in the SC group, but this was statistically insignificant (95% confidence interval 0.68 to 3.9, p ؍ 0.27). Age and preprocedure arrhythmia, but not TC or SC, were independent risk factors for late arrhythmia (p <0.001). No difference was found in the incidence of late, probably embolic, stroke in the TC (3%) versus SC (2%) groups. In conclusion, long-term outcomes after secundum ASD closure using modern methods are excellent. No significant differences were found between TC versus SC with regard to survival, functional capacity, atrial arrhythmias, or embolic neurologic events. Arrhythmia and neurologic events remain long-term risks after ASD closure, especially if the patient had pre-existing arrhythmia.
Pediatric Cardiology, 2019
Atrial septal defect (ASD) is a condition that requires early intervention because of the consequences over the right-side heart. Chronic atrial stretching promotes atrial conduction delay and the imbalance of the conduction homogeneity, which lead to the propensity to atrial arrhythmias (AA). We aim to evaluate the impact of transcatheter closure of ASD on atrial vulnerability markers leading to late AA in young adults. We conducted a prospective, longitudinal study in one hundred patients (mean age 25.2 ± 5.4 years) who underwent transcatheter closure of ASD at Cardiocentro Pediátrico William Soler. P-wave maximum (P max) and P-wave dispersion (P d) were analyzed from 12-lead electrocardiogram. Left-side and right-side intraatrial and interatrial electromechanical delay (EMD) were measured with tissue Doppler imaging. Both electrocardiographic and echocardiographic analyses were performed during the study period. Compared to baseline, there was a significant reduction in P max (p ≤ 0.001) and P d (p ≤ 0.001) after 3 months of procedure. All atrial electromechanical coupling parameters significantly reduced at 6 months of ASD closure and tend to remain at lower values till the last evaluation. Over 9.2 ± 1.6 years of follow-up, 15 subjects (15%) developed AA, of which intraatrial reentrant tachycardia (66.6%) became the main rhythm disturbance. Intra-right atrial EMD ≥ 16 ms (HR 4.08, 95% CI 1.15-14.56; p = 0.03) and P d 45 ms (HR 1.66, 95% CI 1.06-2.59; p = 0.02) were identified as predictors of late AA. Transcatheter device closure of ASD in young adults promotes a significant reduction of electrocardiographic and echocardiographic markers of AA vulnerability, which persist during the long-term follow-up. Nevertheless, P d and interatrial EMD were identified as independent risk factors of AA.
Impact of atrial arrhythmias on outcome in adults with congenital heart disease
International Journal of Cardiology, 2017
Background: Adults with congenital heart disease (ACHD) are affected by atrial arrhythmias (AA). To elucidate the impact of AA on prognosis, we aimed to determine the impact of AA on death, heart failure and stroke in ACHD patients in a prospective nationwide clinical registry. Methods: All patients aged ≥18 years included in the CONCOR registry per October 1st 2015 were analysed. Prior AA was defined as atrial fibrillation, atrial flutter or unspecified AA before inclusion in CONCOR and new-onset AA as a first documented AA during follow-up. The outcomes were death, first stroke and first admission for heart failure (HF). Results: The study cohort comprised 14,224 patients (baseline median age 33.6 [IQR 23-47], male 49.5%, AA n = 1501, complex defect 10.3%, repaired defect 58.9%). Median follow-up was 6.5 years [IQR 3-10]. Adjusting for age, sex, repair status and defect severity, patients with prior AA had higher mortality and more HF admissions, but no increased risk of stroke compared to those without AA (HR = 2.11; 95% CI = 1.79-2.49; p b 0.001, HR = 4.06; 95% CI = 2.66-6.19; p b 0.001 and HR = 1.09; 95% CI = 0.71-1.68; p = 0.698, respectively). New-onset AA during follow-up was significantly associated with stroke (HR = 2.04; 95% CI = 1.05-3.96; p = 0.036). Conclusions: ACHD patients with prior AA have a 2-fold increased risk of death and a 4-fold increased risk of heart failure, but no increased risk for stroke compared to those without AA. Defect severity and age appear to be more important risk factors for stroke than prior AA. Stroke risk is increased only after conversion of new onset AA.
Predictive Factors for Patients Undergoing ASD Device Occlusion Who "Crossover" to Surgery
Pediatric cardiology, 2017
The aim of this study was to define characteristics of those patients who are referred for device closure of an Atrial septal defect (ASD), but identified to "crossover" surgery. All patients who underwent surgical and device (Amplatzer or Helex occluder) closures of secundum ASDs from 2001 to 2010 were reviewed and organized into three groups: surgical closure, device closure, and "crossover" group. 369 patients underwent ASD closure (265 device, 104 surgical). 42 of the 265 patients referred for device closure "crossed over" to the surgical group at various stages of the catheterization procedure. The device group had defect size measuring 14.2 mm (mean) and an ASD index (Defect Size (mm)/BSA) of 14.0 compared to the corresponding values in the surgical group (20.1 mm, ASD index 25.9) (P < 0.001) and in the "crossover" group (20.7 mm, 22.6 ASD index) (P < 0.001). 79 patients in the device group had a deficient rim, and 86% were located...