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Higher incidence arrhythmia post-percutaneous closure of secundum ASD in patients >60 years

ACC 2019
Patients aged >60 years who undergo percutaneous closure of secundum atrial septal defect (ASD) experienced a significantly higher incidence of atrial arrhythmia (AA) post-operatively than younger adult patients, a recent study by Vajapey et al. showed [1].

Atrial septal defect is the most common congenital heart disease in adulthood. Previous studies have shown a higher incidence of arrhythmias, even after closure, in adults compared with children. However, the long-term effects of ASD closure in older patients remain elusive. The objective of the study presented by Dr Ramya Vajapey (Cleveland Clinic, USA) was to better understand the impact of age at the time of ASD closure by comparing the incidence of AA –including atrial fibrillation, atrial flutter, and supraventricular tachycardia– before and after percutaneous closure in adult patients with secundum ASD. The researchers used medical records of patients who underwent percutaneous closure of secundum ASD at the age of ≥18 between 2000-2017. They identified 215 patients of which 144 were female (mean age 51) and 71 were male (mean age 53). The average size of ASD across all age groups was 15.5 mm. The duration of follow up was 2.6 years. Amplatzer (22.3±7.3mm) was the most frequently used device across all age groups (see Table).

Table: Stratification per age group. Data from Vajapey et al. (2019)

No significant difference was observed in new AA among men and women (21.1% vs 20.1%, respectively). Baseline frequencies of AA of patients by ascending age group pre-procedure were 1.7%, 4%, 18.8%, respectively, while the frequencies post-closure were 0%, 2.6%, 16.3%, respectively. The >60 years age group showed a 32.5% incidence of new AA following closure compared with 8.5% and 17.1% for the age groups of 18-40 years and 41-60 years, respectively. Moreover, the total incidence of AAs was 8.5%, 19.7%, and 48.8%, which indicates a significant rise in the post-procedure incidence of AA in patients aged >60 years (P<0.0001). This increased incidence rate highlights the importance of post-operative monitoring for older patients as well as long-term surveillance for AAs after percutaneous ASD closure in this vulnerable population.

1. Vajapey R, et al. Abstract 1282-496. ACC 2019, 16-18 March, New Orleans, USA.

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