Closure of Secundum Atrial Septal Defect and Risk of Incident and Recurrent Arrhythmia

BACKGROUND: Atrial septal defect (ASD) is a simple defect but carries considerable morbidity, especially arrhythmias.

OBJECTIVES: Data on the impact and timing of ASD closure and the risk of (recurrent) arrhythmia remain scarce and will be the focus of this study.

METHODS: This Danish nationwide cohort study included all patients diagnosed with secundum ASD (1977-2024), followed until arrhythmia, death, emigration, or study end (January 2024). The risk of (recurrent) arrhythmias was assessed based on ASD closure status and closure technique.

RESULTS: Among 6469 patients with ASD (43.3% men), 34.6% underwent ASD closure (65.5% surgically and 34.5% percutaneously). The incidence rate of arrhythmia was 13.3 (95% confidence interval [CI], 12.6-14.2) per 1000 person-years (PY), with atrial fibrillation/flutter being the most prevalent. Older age at diagnosis and closure were linked to higher incidence and recurrence of arrhythmia. In time-dependent Cox regression analyses, surgical ASD closure was associated with an increased risk of arrhythmias compared withwith no closure (adjusted hazard ratio [HR], 1.38 [95% CI, 1.19-1.60]), whereas no difference was found for percutaneous closure. Overall, 3 in 4 patients experienced arrhythmia recurrence. ASD closure was associated with a decreased risk of recurrence; however, statistical significance was observed only when comparing percutaneous closure to no closure (adjusted HR, 0.79 [95% CI, 0.64-0.98]).

CONCLUSION: The incidence rate of arrhythmia among patients with ASD was 13 per 1000 PY, with age and closure technique being pivotal factors. Surgical closure was associated with an increased risk of arrhythmias compared with no closure, whereas percutaneous closure was associated with a decreased risk of recurrence.