The importance of pulmonary artery pressures on late atrial arrhythmia in transcatheter and surgically closed ASD type secundum

Abstract Aims Atrial fibrillation and flutter remain an important cause of morbidity in adults with atrial septal defect (ASD). This study aimed at investigating predictors for late (≥ 1 month after repair) atrial arrhythmia. Methods Patients who underwent ASD closure after the age of 18 years, were selected through the databases of three medical centres in Belgium. Preprocedural, periprocedural and follow-up data were extracted. Univariate and multivariate Cox-regression analysis was performed. Kaplan–Meier analysis was performed for any independent predictor of late atrial arrhythmia. Results A total of 155 patients (38 men and 117 women) was included. Twenty-four patients (median age 48.3 years, range 19.9–79.8) underwent surgical and 131 (median age 57.6 years, range 18.2–86.9) underwent transcatheter closure. Thirty-nine patients (25.2%) presented with late atrial arrhythmia. Male gender (P = 0.008), creatinine (P = 0.002), atrial arrhythmia before (P < 0.0001) and within 1 month after repair (P = 0.001) and a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg (P < 0.0001) correlated with late atrial arrhythmia in univariate Cox-regression analysis. Multivariate analysis showed that mPAP ≥ 25 mm Hg (HR 3.72; 95%CI 1.82–7.59; P < 0.0001) and the presence of atrial arrhythmia before (HR 3.22; 95%CI 1.56–6.66; P = 0.002) and within 1 month after repair (HR 2.08; 95%CI 2.08–15.92; P = 0.001) were predictive of late atrial arrhythmia. Kaplan–Meier analysis showed that patients with a mPAP ≥ 25 mm Hg had a higher risk at developing late atrial arrhythmia (P < 0.0001). Conclusion In patients with ASD type secundum, a mPAP ≥ 25 mm Hg is an independent predictor of late atrial arrhythmia. The presence of pulmonary hypertension before repair should raise awareness for atrial arrhythmias and may be used to guide therapy.