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 flutter
- 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.
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