Key result
Following transcatheter closure of secundum atrial septal defects, the overall incidence of new-onset atrial fibrillation or flutter was 1.82 per 100 person-years, with higher rates in the elderly.
Why the study?
New-onset atrial fibrillation and flutter are known complications of transcatheter ASD closure associated with adverse thromboembolic events, motivating an evaluation of their burden and risk factors in adults.
What is the incidence of new-onset atrial fibrillation and flutter following transcatheter closure of secundum ASD in adults?
Meta-Analysis (n=4,788)
What is the incidence of new-onset atrial fibrillation and flutter following transcatheter closure of secundum ASD in adults?
The incidence of new-onset atrial fibrillation and flutter following transcatheter ASD closure in adults is relatively low overall but significantly higher in elderly patients and during the first 2 years of follow-up.
Answers are grounded in this paper and cite their sources.
New-onset AFi/AFl incidence is low after transcatheter ASD closure but higher in elderly patients; leaves open optimal surveillance strategies pending prospective data.
Objective The ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset atrial fibrillation and flutter (AFi/AFl). These arrhythmias confer an increased risk of postoperative stroke, thrombus formation and systemic emboli. This systematic review examines the burden of de novo AFi/AFl in adults following transcatheter closure and seeks to identify risk factors for AFi/AFl development. Methods Studies were identified by a search of MEDLINE, EMBASE and Cochrane databases from inception until 29 April 2020. A meta-analysis of AFi/AFl incidence was performed using a random-effects model. Results A total of 31 studies met inclusion criteria, comprising 4788 adult patients without a history of AFi/AFl. Twenty-three studies were included in quantitative synthesis and demonstrated an overall incidence rate of 1.82 patients per 100 person-years of follow-up (I 2 =83%). In studies that enrolled only patients ≥60 years old, the incidence was 5.21 patients per 100 person-years (I 2 =0%). Studies with follow-up duration ≤2 years reported an incidence of 4.05 per 100 person-years (I 2 =55%) compared with a rate of 1.19 per 100 person-years (I 2 =85%) for studies with follow-up duration >2 years. Conclusions The incidence of new-onset AFi/AFl is relatively low following transcatheter closure of secundum ASDs. The rate of de novo AFi/AFl, however, was significantly higher in elderly patients. Shorter follow-up time was associated with a higher reported incidence of AFi/AFl.
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Himelfarb et al. (2021) conducted a meta-analysis in Ostium secundum atrial septal defect (n=4,788). Transcatheter atrial septal defect closure was evaluated on Incidence of new-onset atrial fibrillation and flutter (AFi/AFl). Following transcatheter closure of secundum atrial septal defects, the overall incidence of new-onset atrial fibrillation or flutter was 1.82 per 100 person-years, with higher rates in the elderly.
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