Objective: To determine whether transcatheter device closure of a secundum atr ial septal defect (ASD) will reduce the risk of developing subsequent atrial arr hythmias. Design: The incidence and predictors of symptom...Objective: To determine whether transcatheter device closure of a secundum atr ial septal defect (ASD) will reduce the risk of developing subsequent atrial arr hythmias. Design: The incidence and predictors of symptomatic atrial tachyarrhyt hmias (AT) were examined in adults undergoing transcatheter closure of ASDs. Set ting: Toronto Congenital Cardiac Centre for Adults. Patients: 132 consecutive pa tients, mean (SD) age 44 (16) years; 74%female. Main outcome measure: Sustained or symptomatic atrial arrhythmias at early follow up (six weeks; n=115) and int ermediate follow up (last clinic visit 17(11)-months post surgery; n=121). Resu lts: 15%of the patients(20 of 132) had AT before the procedure(14 paroxysmal, s ix persistent). Patients without a history of arrhythmia had a low incidence of AT during early follow up (6%) and intermediate follow up (1 %/year), while all patients with persistent AT before closure remained in atria l fibrillation or flutter. Of patients in sinus rhythm but with a previous histo ry of AT, two thirds remained arrhythmia free at follow up, with overall incide nces of paroxysmal and persistent AT of 17%/year and 11%/year. A history of AT before closure (risk ratio (RR) 35.0, 95%con fidence interval (CI) 7.2 to 169 .0) and age ≥55 years at the time of device insertion (RR 5.6,95%CI 1.2 to 25. 0) predicted AT after closure. Conclusions: Device closure of an ASD before the onset of atrial arrhythmias may protect against the subsequent development of ar rhythmia, in particular in patients less than 55 years of age.展开更多
文摘Objective: To determine whether transcatheter device closure of a secundum atr ial septal defect (ASD) will reduce the risk of developing subsequent atrial arr hythmias. Design: The incidence and predictors of symptomatic atrial tachyarrhyt hmias (AT) were examined in adults undergoing transcatheter closure of ASDs. Set ting: Toronto Congenital Cardiac Centre for Adults. Patients: 132 consecutive pa tients, mean (SD) age 44 (16) years; 74%female. Main outcome measure: Sustained or symptomatic atrial arrhythmias at early follow up (six weeks; n=115) and int ermediate follow up (last clinic visit 17(11)-months post surgery; n=121). Resu lts: 15%of the patients(20 of 132) had AT before the procedure(14 paroxysmal, s ix persistent). Patients without a history of arrhythmia had a low incidence of AT during early follow up (6%) and intermediate follow up (1 %/year), while all patients with persistent AT before closure remained in atria l fibrillation or flutter. Of patients in sinus rhythm but with a previous histo ry of AT, two thirds remained arrhythmia free at follow up, with overall incide nces of paroxysmal and persistent AT of 17%/year and 11%/year. A history of AT before closure (risk ratio (RR) 35.0, 95%con fidence interval (CI) 7.2 to 169 .0) and age ≥55 years at the time of device insertion (RR 5.6,95%CI 1.2 to 25. 0) predicted AT after closure. Conclusions: Device closure of an ASD before the onset of atrial arrhythmias may protect against the subsequent development of ar rhythmia, in particular in patients less than 55 years of age.
