TY - JOUR

T1 - Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure

AU - Nyboe, C

AU - Olsen, M S

AU - Nielsen-Kudsk, J E

AU - Hjortdal, V E

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2015/5

Y1 - 2015/5

N2 - OBJECTIVE: To estimate the risk of atrial fibrillation (AF) and stroke and the impact of closure in patients with atrial septal defect (ASD) compared with a general population cohort.METHODS: All adult Danish patients (>18 years) diagnosed with ASD from 1977 to 2009 (N=1168) were identified through population-based registries. Using Cox regression, we compared ASD patients' risk of AF and stroke with an age-matched and gender-matched comparison cohort. We computed prevalence proportions of anticoagulation and antiarrhythmic medicine use before and after closure and described stroke-related mortality.RESULTS: Median follow-up was 9.6 years (range 1-33 years). Patients with ASD had a higher risk of first-time AF (adjusted HR 8.2; 95% CI 6.6 to 10.2) after closure than the comparison cohort, but with no difference between transcatheter and surgical closure (HR 1.5, 95% CI 0.6 to 3.5). Patients without prevalent AF had a 10-year cumulative incidence of AF of 11% (95% CI 9% to 14%) after closure compared with 2% (95% CI 1.8% to 2.5%) in the comparison cohort. Patients with ASD with prevalent AF continued to use anticoagulation medicine after closure/diagnosis. Patients with ASD had increased risk of stroke without closure (adjusted HR 2.6; 95% CI 1.4 to 3.0) and with closure (adjusted HR 2.0; 95% CI 1.4 to 2.7). Risk of stroke after closure was related to AF (HR adjusted for AF 1.3; 95% CI 0.9 to 1.9).CONCLUSIONS: Patients with ASD had a higher risk of first-time AF after closure than the comparison cohort. There was no effect of closure on the use of AF-related medicine in patients with prevalent AF.

AB - OBJECTIVE: To estimate the risk of atrial fibrillation (AF) and stroke and the impact of closure in patients with atrial septal defect (ASD) compared with a general population cohort.METHODS: All adult Danish patients (>18 years) diagnosed with ASD from 1977 to 2009 (N=1168) were identified through population-based registries. Using Cox regression, we compared ASD patients' risk of AF and stroke with an age-matched and gender-matched comparison cohort. We computed prevalence proportions of anticoagulation and antiarrhythmic medicine use before and after closure and described stroke-related mortality.RESULTS: Median follow-up was 9.6 years (range 1-33 years). Patients with ASD had a higher risk of first-time AF (adjusted HR 8.2; 95% CI 6.6 to 10.2) after closure than the comparison cohort, but with no difference between transcatheter and surgical closure (HR 1.5, 95% CI 0.6 to 3.5). Patients without prevalent AF had a 10-year cumulative incidence of AF of 11% (95% CI 9% to 14%) after closure compared with 2% (95% CI 1.8% to 2.5%) in the comparison cohort. Patients with ASD with prevalent AF continued to use anticoagulation medicine after closure/diagnosis. Patients with ASD had increased risk of stroke without closure (adjusted HR 2.6; 95% CI 1.4 to 3.0) and with closure (adjusted HR 2.0; 95% CI 1.4 to 2.7). Risk of stroke after closure was related to AF (HR adjusted for AF 1.3; 95% CI 0.9 to 1.9).CONCLUSIONS: Patients with ASD had a higher risk of first-time AF after closure than the comparison cohort. There was no effect of closure on the use of AF-related medicine in patients with prevalent AF.

KW - Adult

KW - Aged

KW - Anti-Arrhythmia Agents/therapeutic use

KW - Anticoagulants/therapeutic use

KW - Atrial Fibrillation/epidemiology

KW - Cardiac Catheterization/statistics & numerical data

KW - Cohort Studies

KW - Denmark/epidemiology

KW - Female

KW - Heart Septal Defects, Atrial/epidemiology

KW - Humans

KW - Male

KW - Middle Aged

KW - Postoperative Complications/epidemiology

KW - Risk Factors

KW - Stroke/epidemiology

U2 - 10.1136/heartjnl-2014-306552

DO - 10.1136/heartjnl-2014-306552

M3 - Journal article

C2 - 25691512

VL - 101

SP - 706

EP - 711

JO - Heart

JF - Heart

SN - 1355-6037

IS - 9

ER -