Key result
Atrial fibrillation in patients with atrial septal defects is primarily driven by atrial dilation, and management involves surgical or percutaneous closure combined with arrhythmia-specific procedures.
Why the study?
How does surgical or percutaneous closure of atrial septal defects affect mortality, symptoms, and the incidence of atrial fibrillation?
How does surgical or percutaneous closure of atrial septal defects affect mortality, symptoms, and the incidence of atrial fibrillation?
Surgical or percutaneous closure of ASDs reduces mortality and symptoms but is limited in preventing atrial fibrillation unless combined with an arrhythmia-specific procedure.
ASD closure may reduce mortality/symptoms but not AF without adjunctive procedures; leaves open optimal strategies pending prospective trials.
Atrial fibrillation (AF) is a common complication in patients with atrial septal defects (ASDs). The link between AF and ASD is fairly complex and entails modifications in electrophysiologic, contractile and structural properties, at the cellular and tissue level, of both atria, mainly due to chronic atrial stretch and dilation. Surgical repair or percutaneous closure of ASDs are equally effective in reducing mortality and symptoms but limited in preventing or curbing AF, unless combined with an arrhythmia-specific procedure. Transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) have improved the safety and success of the above procedures. Finally, clearer understanding of the pathophysiology of AF in patients with ASD (and CHF, in general) has led to target-specific advances in medical management.
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Blake et al. (2008) conducted a review in Atrial Septal Defect and Atrial Fibrillation. Atrial fibrillation in patients with atrial septal defects is primarily driven by atrial dilation, and management involves surgical or percutaneous closure combined with arrhythmia-specific procedures.
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