Abstract 12897: Long-term Risk of Atrial Fibrillation in Adults Diagnosed With Atrial Septal Defect in Childhood
Atrial fibrillation (AF) is very common in patients with atrial septal defects (ASD). The impact of closure on the prevalence and especially the correct timing is controversial. We investigated the risk of AF in patients diagnosed with ASD in childhood, both with and without closure, compared with a general population cohort.
Data on all Danish ASD patients diagnosed before the age of 18 years between 1963 and 1994 was obtained from national registries. Follow-up was continued until outcome, death, emigration or 31st of Dec 2011. Hazard ratios were calculated using Cox proportional hazards regression and cumulative incidences estimated using Fine and Gray’s competing risk regression.
A total of 1,111 patients met the inclusion criteria, and each was matched on age and gender with 10 controls. Mean age at diagnosis was 4.9 years (range 0-17.9 years). Mean follow-up since diagnosis was 26.3 years (range 1-53.3 years). A total of 642 patients had closure performed either surgically or percutaneously with 402 before the age of 10 years.
Patients with an unclosed ASD had an increased risk of AF (HR 16.4, 95% CI: 6.8; 39.8) compared with the general population cohort. For patients with closure the risk was similarly high (HR 18.1, 95% CI: 9.8; 33.5). Closure before (HR 17.9, 95% CI: 7.5; 42.7) and after (HR 18.4, 95% CI: 7.7; 43.8) the age of 10 did not affect the risk of AF later in life. Cumulative incidences after 10 years was 0.6% [0.1; 4.4] and after 50 years 9.8% [6.7; 14.12].
In conclusion, risk of AF is high despite closure in childhood. Closure being insufficient protection against development of AF in adulthood speaks for causality other than the mere presence of an ASD. Furthermore, ASD patients (regardless of closure) call for follow-up investigation past the 5th decade.
Author Disclosures: Z. Karunanithi: None. C. Nyboe: None. V.E. Hjortdal: None.
- © 2015 by American Heart Association, Inc.