Atrial septal defect closure is associated with a reduced prevalence of atrial tachyarrhythmia in the short to medium term: a systematic review and meta-analysis

Abstract

Atrial tachyarrhythmias are a common complication of atrial septal defects. The objective was to determine the effect of atrial septal defect closure on pre-existing atrial tachyarrhythmias and to investigate if such an effect is present after either surgical or percutaneous closure. Medline, EMBASE, Cochrane Library, and Google Scholar databases were searched between 1967 and 2009. The search was expanded using the 'related articles' function and reference lists of key studies. All studies reporting pre- and post- closure incidence (or prevalence) of atrial tachyarrhythmias in the same patient groups were included. Data were independently extracted by two authors according to a pre-defined protocol. Incongruities were settled by consensus decision. Twenty six studies were identified including 1841 patients who underwent surgical closure and 945 who underwent percutaneous closure. Meta-analysis using a random effects model demonstrated a reduction in the prevalence of atrial tachyarrhythmias following atrial septal defect closure [OR = 0.66 (95% CI 0.57-0.77)]. This effect was demonstrated after both percutaneous [OR = 0.49 (95% CI 0.32-0.76)] and surgical closure [OR = 0.72 (95% CI 0.60-0.87)]. Immediate (<30 days) and mid-term (30 days - 5 years) follow-up also demonstrated a reduction in AT prevalence [ORs of 0.80 (95% CI 0.66-0.97) and 0.47 (95% CI 0.36-0.62) respectively]. Atrial septal defect closure, whether surgical or percutaneous, is associated with a reduction in the post-closure prevalence of pre-existing atrial tachyarrhythmias and atrial fibrillation in the short to medium term.

Feasibility, Safety and Long-Term Follow-Up of Transcatheter Closure of Secundum Atrial Septal Defects with Deficient Rims

“…However, there were no significant changes in the long-term follow-up of 3 patients with III°AVB, even at 1 year postoperation. Vecht et al [17] also examined the incidence of arrhythmia after ASD intervention and showed that the incidence rate of arrhythmia decreases with time. The results of this study are consistent with the results of our meta-analysis.…”

Does patent foramen ovale closure have an anti-arrhythmic effect? A meta-analysis

“…Previous studies have investigated the effect of ASD closure on AT, showing that closure may lead to new AT or eliminate pre-existing AT [23]. A meta-analysis conducted by our own group, comprising twenty six studies and 2786 patients showed that both surgical and percutaneous ASD closures are associated with a reduction in pre-existing AT in the short to medium term [24]. A number of studies have also looked at the development of new-onset AT following percutaneous PFO closure, but no large trials have specifically investigated the effect of PFO closure on patients with pre-existing AT to identify any anti-arrhythmic effect.…”

Almanac 2012: Congenital heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology

“…75 Meta-analysis using a random effects model demonstrated a reduction in the prevalence of atrial tachyarrhythmias after atrial septal defect closure (OR 0.66, 95% CI 0. 57-0.77).…”