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Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure
  1. C Nyboe1,2,
  2. M S Olsen2,
  3. J E Nielsen-Kudsk3,
  4. V E Hjortdal1
  1. 1Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  3. 3Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
  1. Correspondence to Dr Camilla Nyboe, Department of Cardiothoracic Surgery, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N 8200, Denmark; camilla{at}nyboe.nu

Abstract

Objective To estimate the risk of atrial fibrillation (AF) and stroke and the impact of closure in patients with atrial septal defect (ASD) compared with a general population cohort.

Methods All adult Danish patients (>18 years) diagnosed with ASD from 1977 to 2009 (N=1168) were identified through population-based registries. Using Cox regression, we compared ASD patients’ risk of AF and stroke with an age-matched and gender-matched comparison cohort. We computed prevalence proportions of anticoagulation and antiarrhythmic medicine use before and after closure and described stroke-related mortality.

Results Median follow-up was 9.6 years (range 1–33 years). Patients with ASD had a higher risk of first-time AF (adjusted HR 8.2; 95% CI 6.6 to 10.2) after closure than the comparison cohort, but with no difference between transcatheter and surgical closure (HR 1.5, 95% CI 0.6 to 3.5). Patients without prevalent AF had a 10-year cumulative incidence of AF of 11% (95% CI 9% to 14%) after closure compared with 2% (95% CI 1.8% to 2.5%) in the comparison cohort. Patients with ASD with prevalent AF continued to use anticoagulation medicine after closure/diagnosis. Patients with ASD had increased risk of stroke without closure (adjusted HR 2.6; 95% CI 1.4 to 3.0) and with closure (adjusted HR 2.0; 95% CI 1.4 to 2.7). Risk of stroke after closure was related to AF (HR adjusted for AF 1.3; 95% CI 0.9 to 1.9).

Conclusions Patients with ASD had a higher risk of first-time AF after closure than the comparison cohort. There was no effect of closure on the use of AF-related medicine in patients with prevalent AF.

  • CONGENITAL HEART DISEASE

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