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Original research
Atrial fibrillation following transcatheter atrial septal defect closure: a systematic review and meta-analysis
  1. Jonah Daniel Himelfarb1,
  2. Healey Shulman1,
  3. Christopher James Olesovsky1,
  4. Rawan K Rumman1,
  5. Laura Oliva2,
  6. Joshua Friedland1,
  7. Ashley Farrell3,
  8. Ella Huszti2,4,
  9. Eric Horlick5,
  10. Lusine Abrahamyan2,6
  1. 1 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
  3. 3 Library and Information Services, University Health Network, Toronto, Ontario, Canada
  4. 4 Biostatistics Research Unit, University Health Network, Toronto, Ontario
  5. 5 Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto, Ontario, Canada
  6. 6 Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Jonah Daniel Himelfarb, University of Toronto, Toronto, ON M5S 1A1, Canada; jonah.himelfarb{at}


Objective The ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset atrial fibrillation and flutter (AFi/AFl). These arrhythmias confer an increased risk of postoperative stroke, thrombus formation and systemic emboli. This systematic review examines the burden of de novo AFi/AFl in adults following transcatheter closure and seeks to identify risk factors for AFi/AFl development.

Methods Studies were identified by a search of MEDLINE, EMBASE and Cochrane databases from inception until 29 April 2020. A meta-analysis of AFi/AFl incidence was performed using a random-effects model.

Results A total of 31 studies met inclusion criteria, comprising 4788 adult patients without a history of AFi/AFl. Twenty-three studies were included in quantitative synthesis and demonstrated an overall incidence rate of 1.82 patients per 100 person-years of follow-up (I2=83%). In studies that enrolled only patients ≥60 years old, the incidence was 5.21 patients per 100 person-years (I2=0%). Studies with follow-up duration ≤2 years reported an incidence of 4.05 per 100 person-years (I2=55%) compared with a rate of 1.19 per 100 person-years (I2=85%) for studies with follow-up duration >2 years.

Conclusions The incidence of new-onset AFi/AFl is relatively low following transcatheter closure of secundum ASDs. The rate of de novo AFi/AFl, however, was significantly higher in elderly patients. Shorter follow-up time was associated with a higher reported incidence of AFi/AFl.

  • atrial fibrillation
  • heart septal defects
  • atrial
  • atrial flutter
  • meta-analysis
  • systematic reviews as topic

Data availability statement

Data are available upon reasonable request.

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  • Contributors All authors were involved in the conceptualisation and design of the review. RKR established the search strategies with assistance from AF. JDH, HS, CJO and JF screened the titles, abstracts and full articles as per the protocol. JFH and HS assessed the quality of the included studies. JDH, LO, E Huszti and LA analysed the data. All authors discussed the findings. JDH drafted the manuscript. All authors provided critical feedback and contributed to the final manuscript. JDH and LA are responsible for the overall content as guarantors.

  • Funding This study was supported through funding from the Peter Munk Chair in Structural Heart Disease Interventions.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.