Po-04-144 impact of age on atrial arrhythmia outcomes after percutaneous asd closure

Atrial Septal Defects (ASD) are one of the most common congenital heart defects, and if unrepaired, increase the risk of atrial fibrillation (AF) and atrial flutter (AFL). AF/AFL are linked to an increased risk of stroke and heart failure yet, it is not clear from existing data whether percutaneous ASD closure reduces the overall burden of AF/AFL and whether AF/AFL prevalence is impacted by closure age. To determine the effect of age at ASD closure on the prevalence of late atrial arrhythmias. All patients who underwent percutaneous ASD closure at Cleveland Clinic from January 2010 to July 2021 were included. Patients without right-sided dilatation and Qp:Qs < 1.5, iatrogenic ASDs, and those with Eisenmenger syndrome were excluded. A non-linear logistic mixed model informed a temporal decomposition model used to analyze the association between age at ASD closure and prevalence of AF/AFL, adjusting for gender and presence of pre-closure AF/AFL. A total of 192 patients met inclusion criteria, 121 (63%) female with a median age of 41.5 years (IQR 19-61) at time of ASD closure. Median follow up time was 2.7 years (IQR 0.64-4.7). 170 (89%) patients had a total of 681 records including ECGs and ambulatory rhythm monitors. Pre-procedural AF/AFL was associated with higher likelihood of late (>6 months) AF/AFL. The prevalence of post-ASD closure AF/AFL was composed of two phases: an early peaking phase of 13% at week 1 with a gradual decrease to 3.2% by 6 months. There was a late rising prevalence from 6 months up to 6 years from 3.2% to 4.7% (Figure 1a). Age ≥ 40 years was associated with higher likelihood of early (≤ 6 months) and late (> 6 months) post procedural AF/AFL prevalence (Figure 1b). Post-device closure, only 7 (3.6%) patients required cardioversions at a median time of 2.6 months, and 5 (2.6%) required ablations at a median time of 7.4 months post ASD closure. There were only 10 arrhythmia related ER visits during the follow up period. There is an increased prevalence of AF/AFL immediately post ASD closure that declines by 6 months. Patients older than 40 years of age and those with pre-procedure AF/AFL have ongoing risk for late AF/AFL post ASD closure. Rhythm monitoring before ASD closure may be indicated in age ≥ 40 to identify those at higher risk of developing late AF/AFL. Parametric estimate of prevalence of AF or AFL after percutaneous ASD closureTime1 day1 week2 week1 month6 month1 year3 year5 year6 yearOverall (%)0.8813106.73.23.54.24.64.7Stratified by age (%)<4002.61.80.630.0130.002000≥401.34332154.656.26.97.1 Open table in a new tab