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Atrial fibrillation following transcatheter atrial septal defect closure: a systematic review and meta-analysis.

Authors
  • Himelfarb, Jonah Daniel1
  • Shulman, Healey2
  • Olesovsky, Christopher James2
  • Rumman, Rawan K2
  • Oliva, Laura3
  • Friedland, Joshua2
  • Farrell, Ashley4
  • Huszti, Ella3, 5
  • Horlick, Eric6
  • Abrahamyan, Lusine3, 7
  • 1 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada [email protected] , (Canada)
  • 2 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 3 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 4 Library and Information Services, University Health Network, Toronto, Ontario, Canada. , (Canada)
  • 5 Biostatistics Research Unit, University Health Network, Toronto, Ontario.
  • 6 Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto, Ontario, Canada. , (Canada)
  • 7 Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. , (Canada)
Type
Published Article
Journal
Heart
Publisher
BMJ
Publication Date
Jul 13, 2022
Volume
108
Issue
15
Pages
1216–1224
Identifiers
DOI: 10.1136/heartjnl-2021-319794
PMID: 34675040
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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