Atrial fibrillation following transcatheter atrial septal defect closure: a systematic review and meta-analysis
Jonah Himelfarb, Healey Shulman, Christopher Olesovsky, Rawan K. Rumman, Laura Oliva, Joshua Friedland, Ashley Farrell, Ella Huszti, Eric Horlick, Lusine Abrahamyan
Abstract
Objective The ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset atrial fibrillation and flutter (AFi/AFl). These arrhythmias confer an increased risk of postoperative stroke, thrombus formation and systemic emboli. This systematic review examines the burden of de novo AFi/AFl in adults following transcatheter closure and seeks to identify risk factors for AFi/AFl development. Methods Studies were identified by a search of MEDLINE, EMBASE and Cochrane databases from inception until 29 April 2020. A meta-analysis of AFi/AFl incidence was performed using a random-effects model. Results A total of 31 studies met inclusion criteria, comprising 4788 adult patients without a history of AFi/AFl. Twenty-three studies were included in quantitative synthesis and demonstrated an overall incidence rate of 1.82 patients per 100 person-years of follow-up (I 2 =83%). In studies that enrolled only patients ≥60 years old, the incidence was 5.21 patients per 100 person-years (I 2 =0%). Studies with follow-up duration ≤2 years reported an incidence of 4.05 per 100 person-years (I 2 =55%) compared with a rate of 1.19 per 100 person-years (I 2 =85%) for studies with follow-up duration >2 years. Conclusions The incidence of new-onset AFi/AFl is relatively low following transcatheter closure of secundum ASDs. The rate of de novo AFi/AFl, however, was significantly higher in elderly patients. Shorter follow-up time was associated with a higher reported incidence of AFi/AFl.