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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
  1. Joshua A Vecht1,
  2. Srdjan Saso1,
  3. Christopher Rao1,
  4. Konstantinos Dimopoulos2,
  5. Julia Grapsa1,
  6. Cesare M Terracciano3,
  7. Nicholas S Peters4,
  8. Petros Nihoyannopoulos5,
  9. Elaine Holmes6,
  10. Michael A Gatzoulis7,
  11. Thanos Athanasiou8
  1. 1Surgical Epidemiology Unit, Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, UK
  2. 2Adult Congenital Heart Centre, Royal Brompton Hospital National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
  3. 3Cellular Electrophysiology Group, Harefield Heart Science Centre, National Heart and Lung Institute, Imperial College London, Harefield Hospital, UK
  4. 4Cardiac Electrophysiology, National Heart and Lung Institute, Imperial College London, St Mary's Hospital, London, UK
  5. 5Department of Cardiology, National Heart and Lung Institute, Imperial College London, The Hammersmith Hospital, London, UK
  6. 6Department of Biomolecular Medicine, Imperial College London, Sir Alexander Fleming Building, London, UK
  7. 7Adult Congenital Heart Centre, Royal Brompton Hospital National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
  8. 8Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, The Hammersmith Hospital, London, UK
  1. Correspondence to Srdjan Saso, Clinical Research Fellow, Department of Biosurgery and Surgical Technology, 10th Floor, QEQM Wing, St Mary's Hospital, London W2 1NY, UK; srdjan.saso{at}imperial.ac.uk

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.

  • Atrial septal defect
  • surgical repair
  • transcatheter closure
  • atrial tachyarrhythmia
  • atrial arrhythmias
  • atrial fibrillation

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Footnotes

  • Funding This work was supported by the National Institute of Health Research Biomedical Research Centre and British Heart Foundation (RG05/009).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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