Long-term outcome of invasive electrophysiological studies and catheter ablation in patients with patent foramen ovale and atrial septal defect–A single-center retrospective cohort study

Introduction: Patients with atrial septal defect (ASD) and patent foramen ovale (PFO) are prone to atrial arrhythmias due to structural and surgical alterations. While radiofrequency catheter ablation (RFCA) is a common treatment, arrhythmia recurrence remains a clinical challenge. This study aimed to assess arrhythmia patterns, procedural outcomes, and long-term recurrence following electrophysiological interventions. Methods: A retrospective cohort study was performed at a tertiary center including patients with ASD or PFO undergoing invasive electrophysiological procedures. Clinical and procedural data were extracted from medical records. Arrhythmias were classified based on electrocardiographic and electrophysiological findings. Kaplan-Meier analysis was used to assess event-free survival for arrhythmia recurrence. Results: Among 87 patients (57.5 % female, median age 46.4 years), 82.8 % underwent RFCA as the first intervention. The most common arrhythmias were non-cavo-tricuspid isthmus (CTI) dependent intra-atrial reentrant tachycardia (35.4 %) and atrial fibrillation (18.6 %). Acute procedural success was achieved in 97.2 % of patients. Recurrence-free survival after the first RFCA was 83.6 % at 1 year, 64.2 % at 3 years, and 60.0 % at 5 years. After the last RFCA, recurrence-free survival improved to 88.3 % at 1 year and 74.3 % at 5 years. Conclusion: In patients with ASD and PFO, RFCA is safe and acutely effective but followed by arrhythmia recurrence in a quarter of patients. The evolving arrhythmic substrate highlights the need for early intervention strategies and emerging technologies to optimize long-term outcomes in this patient population.