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Original research
Stroke in patients with secundum atrial septal defect and sequelae after transcatheter closure
  1. Stephen J Dolgner1,2,
  2. Zachary Louis Steinberg1,
  3. Thomas K Jones1,3,
  4. Mark Reisman1,
  5. Jonathan Buber1
  1. 1Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  2. 2Adult Congenital Heart Program, Texas Children's Hospital, Houston, Texas, USA
  3. 3Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
  1. Correspondence to Dr Stephen J Dolgner, Adult Congenital Heart Program, Texas Children's Hospital, Houston, TX 77030, USA; sjdolgne{at}texaschildrens.org

Abstract

Objective To evaluate the frequency of and risk factors for stroke as a presenting feature in adult patients with secundum atrial septal defect (ASD); rates of post-closure atrial fibrillation (AF) and stroke were also assessed.

Methods We retrospectively reviewed adult patients who presented with an ASD between 2002 and 2018, excluding those with known atrial arrhythmias. Risk factors for stroke were identified using multivariable logistic regression. Post-closure stroke was evaluated using survival analysis stratified by the presence of post-procedure AF.

Results Of 346 patients with ASD (median age 44 years), 34 (10%) presented with a history of stroke. Independent risk factors included elevated body mass index over 25 (OR: 18.2; 95% CI: 4.0 to 82.2; p<0.001), smoking (OR: 9.5; 95% CI: 3.8 to 23.9; p<0.001) and a prominent Eustachian valve (OR: 9.2; 95% CI: 3.4 to 25.2; p<0.001). A scoring system based on these three parameters provided robust stroke risk stratification. During a median follow-up of 12 months after closure, 12 patients (4%) experienced AF and 4 patients (1%) had a new stroke. AF was highly associated with development of stroke post-closure (p<0.001).

Conclusions In this study population, the incidence of stroke prior to ASD closure among patients without atrial arrhythmias was 10%. Risk factors included obesity, smoking and prominent Eustachian valve anatomy. Lifestyle changes should be recommended for at-risk patients, and it may be reasonable to consider ASD closure in the absence of haemodynamic indications in patients at increased risk of stroke.

  • atrial septal defect
  • stroke
  • device closure

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Footnotes

  • Twitter @StephenDolgner

  • Contributors JB conceived of the study, and SD, ZLS and JB designed the study. SD carried out the analysis. SD, ZLS, TKJ, MR and JB contributed to the interpretation of the data. SD drafted the initial manuscript, and all authors revised it critically. All of the authors approve of the final version to be published. All of the authors agree to be accountable for all aspects of the work to ensure that any questions related to the work will be appropriately investigated and resolved. SD and JB accept responsibility for the data and overall content as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ZLS is a consultant for Medtronic. TKJ receives research grant support and is a consultant for Abbott Laboratories and WL Gore and Associates.

  • 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.

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