Pathophysiology and Management of Arrhythmias Associated with Atrial Septal Defect and Patent Foramen Ovale

Abstract

Atrial septal defects (ASDs) are among the most common of congenital heart defects and are frequently associated with atrial arrhythmias. Atrial and ventricular geometrical remodelling secondary to the intracardiac shunt promotes evolution of the electrical substrate, predisposing the patient to atrial fibrillation and other arrhythmias. Closure of an ASD reduces the immediate and long-term prevalence of atrial arrhythmias, but the evidence suggests that patients remain at an increased long-term risk in comparison with the normal population. The closure technique itself and its timing impacts future arrhythmia risk profile while subsequent transseptal access following surgical or device closure is complicated. Newer techniques combined with increased experience will help to alleviate some of the difficulties associated with optimal management of arrhythmias in these patients.

Closure, Anticoagulation, or Antiplatelet Therapy for Cryptogenic Stroke With Patent Foramen Ovale: Systematic Review of Randomized Trials, Sequential Meta‐Analysis, and New Insights From the CLOSE Study

“…Pathophysiology of new‐onset atrial fibrillation is not unique. It has been hypothesized that early events of atrial fibrillation after PFO closure are likely to be triggered by local inflammation 38. Interestingly, our analysis suggests that absolute risks of new‐onset atrial fibrillation could differ according to type of devices used in trials.…”

Management of supraventricular arrhythmias in adults with congenital heart disease

“…In patients with atrial septal defect (ASD) repair prior to age 15, SVT was observed in 16% during mean follow-up of 35 years,7 while patients with uncorrected ASD or surgery as adult experience SVT in up to 50% 8. Patients with repair of tetralogy of Fallot also have an age-dependent risk of up to 20% to develop IART 9 10.…”

Atrial Arrhythmia in Atrial Septal Defect Patient: A Case Report and Review of Literature

“…6 The prevalence atrial arrhythmias in ASD is < 2% in ages around 20 years old, 10-15% in patients ages 40 years old and 20-40% in patients ages 60 years old (measured preclosure). 4 The estimated incidence of atrial arrhythmia is approximately 10 % under the age of 40 years in unoperated adults, rising to at least 20% with increased age, pulmonary arterial pressure and systemic hypertension. 4 To reduce the morbidity associated with atrial flutter and fibrillation, the timely closure of atrial septal defects is warranted.…”

“…4 The estimated incidence of atrial arrhythmia is approximately 10 % under the age of 40 years in unoperated adults, rising to at least 20% with increased age, pulmonary arterial pressure and systemic hypertension. 4 To reduce the morbidity associated with atrial flutter and fibrillation, the timely closure of atrial septal defects is warranted. 9 Additional studies have suggested that the incidence is increased in male patients, those with chronic obstructive pulmonary disease, reduced ejection fraction and hypertension.…”

“…9 Additional studies have suggested that the incidence is increased in male patients, those with chronic obstructive pulmonary disease, reduced ejection fraction and hypertension. 4 The consequences of left to right shunt across an ASD are RV volume overload and pulmonary overcirculation . 10 Atrial arrhytmia are a common result of long standing right side heart volume and pressure overload.…”