Long-Term Risk of Atrial Fibrillation and Stroke in Patients With Atrial Septal Defect Diagnosed in Childhood

Karunanithi, Zarmiga; Nyboe, Camilla; Hjortdal, Vibeke E.

doi:10.1016/j.amjcard.2016.10.015

Cited by 59 publications

(41 citation statements)

References 29 publications

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“…70 In cases of congenital heart disease, ventricular assist devices, or extracorporeal membrane oxygenation, thrombus can occur from stasis or paradoxical venous embolism. The role of arrhythmia in childhood stroke and clot formation is less clearly defined, although a recent report of increased risk of arrhythmia and stroke in adults with a history of congenital atrial septal disease 139 raises the possibility that arrhythmia is an underrecognized cause of childhood stroke, especially in those with a history of benign congenital heart disease. Similarly, the role of PFO in childhood stroke remains uncertain.…”

Section: Cardiacmentioning

confidence: 99%

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Ferriero¹,

Fullerton²,

Bernard³

et al. 2019

Stroke

494

515

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Purpose-Much has transpired since the last scientific statement on pediatric stroke was published 10 years ago. Although stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and stroke. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results-Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section. Conclusions-Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic stroke, and updates in regard to areas of childhood stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field. (Stroke. 2019;50:e00-e00.

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Section: Cardiacmentioning

confidence: 99%

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Ferriero¹,

Fullerton²,

Bernard³

et al. 2019

Stroke

494

515

View full text Add to dashboard Cite

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“…2 Most children with an isolated atrial septal defect are asymptomatic; however, signs of the adverse effects of an atrial septal defect increase with advancing age. Indeed, patients with an atrial septal defect have increased risk of developing heart failure, a higher risk of stroke, atrial fibrillation, 3,4 pneumonia, 5 and a reduced life expectancy regardless of closure in childhood or adulthood. 6,7 Consequently, patients with a repaired atrial septal defect, who for a long time were perceived as completely healthy after correction of the defect, warrant renewed attention.…”

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confidence: 99%

Pacemaker and conduction disturbances in patients with atrial septal defect

et al. 2020

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AbstractObjective:To determine the prevalence of pacemaker and conduction disturbances in patients with atrial septal defects.Design:All patients with an atrial septal defect born before 1994 were identified in the Danish National Patient Registry, and 297 patients were analysed for atrioventricular block, bradycardia, right bundle branch block, left anterior fascicular block, left posterior fascicular block, pacemaker, and mortality. Our results were compared with pre-existing data from a healthy background population. Further, outcomes were compared between patients with open atrial septal defects and atrial septal defects closed by surgery or transcatheter.Results:Most frequent findings were incomplete right bundle branch block (40.1%), left anterior fascicular block (3.7%), atrioventricular block (3.7%), and pacemaker (3.7%). Average age at pacemaker implantation was 32 years. Patients with defects closed surgically or by transcatheter had an increased prevalence of atrioventricular block (p < 0.01), incomplete right bundle branch block (p < 0.01), and left anterior fascicular block (p = 0.02) when compared to patients with unclosed atrial septal defects. At age above 25 years, there was a considerably higher prevalence of atrioventricular block (9.4% versus 0.1%) and complete right bundle branch block (1.9% versus 0.4%) when compared to the background cohorts.Conclusions:Patients with atrial septal defects have a considerably higher prevalence of conduction abnormalities when compared to the background population. Patients with surgically or transcatheter closed atrial septal defects demonstrated a higher demand for pacemaker and a higher prevalence of atrioventricular block, incomplete right bundle branch block, and left anterior fascicular block when compared to patients with unclosed atrial septal defects.

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“…The link between ASD and AF was previously reported and RA catheter ablation was suggested in selected cases . RA stretch and dyssynchrony caused by left‐to‐right shunt promotes changes in atrial refractoriness and ionic currents (electrical remodeling), as well as tissue remodeling due to atrial fibrosis (structural remodeling), that generate a favorable substrate for AF initiation.…”

Section: Discussionmentioning

confidence: 87%

Right atrial function by speckle tracking echocardiography in atrial septal defect: Prediction of atrial fibrillation

Vitarelli

Madon

Gaudio

et al. 2018

Clinical Cardiology

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Long-Term Risk of Atrial Fibrillation and Stroke in Patients With Atrial Septal Defect Diagnosed in Childhood

Cited by 59 publications

References 29 publications

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Pacemaker and conduction disturbances in patients with atrial septal defect

Right atrial function by speckle tracking echocardiography in atrial septal defect: Prediction of atrial fibrillation

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