Background Atrial flutter and atrial fibrillation are causesof morbidity in adults with an atrial septal defect. In thisstudy, we attempted to identify risk factors for atrial flutterand fibrillation both before and after the surgical closureof an atrial septal defect.
Methods We searched for preoperative and postoperative atrialflutter or fibrillation in 213 adult patients (82 men and 131women) who underwent surgical closure of atrial septal defectsbecause of symptoms, a substantial left-to-right shunt (ratioof pulmonary to systemic blood flow, >1.5:1), or both atToronto Hospital between 1986 and 1997.
Results Forty patients (19 percent) had sustained atrial flutteror fibrillation before surgery. As compared with the patientswho did not have atrial flutter or fibrillation before surgery,those who did were older (mean [±SD] age, 59±11vs. 37±13 years, P<0.001) and had higher mean pulmonaryarterial pressures (25.0±9.7 vs. 19.7±8.2 mm Hg,P=0.001). There were no perioperative deaths. After a mean follow-upperiod of 3.8±2.5 years, 24 of the 40 patients (60 percent)continued to have atrial flutter or fibrillation. The mean ageof these patients was greater than that of the 16 who convertedto sinus rhythm (P=0.02). New-onset atrial flutter or atrialfibrillation was more likely to have developed at follow-upin patients who were older than 40 years at the time of surgerythan in those who were 40 or younger (5 of 67 vs. 0 of 106,P=0.008). Late events (those occurring more than one month aftersurgery) included stroke in six patients (all but one with atrialflutter or fibrillation, one of whom died) and death from noncardiaccauses in two patients. Multivariate analysis showed that olderage (>40 years) at the time of surgery (P=0.001), the presenceof preoperative atrial flutter or fibrillation (P<0.001),and the presence of postoperative atrial flutter or fibrillationor junctional rhythm (P=0.02) were predictive of late postoperativeatrial flutter or fibrillation.
Conclusions The risk of atrial flutter or atrial fibrillationin adults with atrial septal defects is related to the age atthe time of surgical repair and the pulmonary arterial pressure.To reduce the morbidity associated with atrial flutter and fibrillation,the timely closure of atrial septal defects is warranted.
Source Information
From the University of Toronto Congenital Cardiac Centre for Adults, Toronto Hospital, and the Department of Medicine, University of Toronto — both in Toronto.
Address reprint requests to Dr. Gatzoulis at the Toronto Hospital, Toronto Congenital Cardiac Centre, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada, or at gatzoul{at}ibm.net.
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