Outcome of transcatheter atrial septal defect closure in a nationwide cohort
AbstractBackground Transcatheter (TC) atrial septal defect (ASD) closure has been the mainstay of therapy for secundum-type ASDs for over 20 years.Aims This nationwide cohort evaluated the long-term outcome of transcatheter-closed ASDs.Methods The study enrolled every transcatheter ASD closure perfo...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2023-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2023.2178669 |
| _version_ | 1797353764954308608 |
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| author | V. Muroke M. Jalanko J. Haukka J. Hartikainen A. Tahvanainen H. Ukkonen K. Ylitalo J. Pihkala J. Sinisalo |
| author_facet | V. Muroke M. Jalanko J. Haukka J. Hartikainen A. Tahvanainen H. Ukkonen K. Ylitalo J. Pihkala J. Sinisalo |
| author_sort | V. Muroke |
| collection | DOAJ |
| description | AbstractBackground Transcatheter (TC) atrial septal defect (ASD) closure has been the mainstay of therapy for secundum-type ASDs for over 20 years.Aims This nationwide cohort evaluated the long-term outcome of transcatheter-closed ASDs.Methods The study enrolled every transcatheter ASD closure performed in Finland from 1999 to 2019. Five age, sex, and municipality-matched controls per ASD patient were gathered from the general population. The median follow-up period was 5.9 years (range 0–20.8). We used the hospital discharge register to gather all hospital visits and diagnoses. Closure complications and echocardiographic changes were collected from the electronic health records.Results Transcatheter ASD closure was performed in 1000 patients (68.5% females) during the study period. The median (range) age at the time of the procedure was 37.9 (1.8–87.5) years. ASD patients had an increased risk for new-onset atrial fibrillation (RR 2.45, 95% CI: 1.84–3.25), migraine (RR 3.61, 95% CI: 2.54–5.14), ischemic heart disease (RR 1.73, 95% CI: 1.23–2.45), ventricular fibrillation/tachycardia (RR 3.54 (95% CI: 1.48–8.43) and AV conduction disorder (RR 3.60, 95% CI: 1.94–6.70) compared to the control cohort. Stroke risk was not increased (RR 1.36, 95% CI: 0.91–2.03). Adverse events occurred in 6.3% (n = 63) of the patients, including four erosions and ten device embolizations.Conclusion After TC closure of ASD, patients had a higher risk of new-onset atrial fibrillation and migraine than controls without ASD. As novel findings, we found an increased risk for ischemic heart disease, AV conduction disorders, and ventricular fibrillation/tachycardia.Key messagesEven though patients have an excellent overall prognosis after percutaneous ASD closure, the increased incidence of major comorbidities like atrial fibrillation and heart failure prompts more thorough lifelong follow-up.This study’s novel findings revealed the increased risk for ischemic heart disease, AV conduction disorders, or ventricular tachycardia/fibrillation during the follow-up.Major complications after the closure are rare; erosion is seen in 0.4% of the patients and embolization in 1.0% of the patients. |
| first_indexed | 2024-03-08T13:35:44Z |
| format | Article |
| id | doaj.art-c78f439f344146dcb3d96950828eda1d |
| institution | Directory Open Access Journal |
| issn | 0785-3890 1365-2060 |
| language | English |
| last_indexed | 2024-03-08T13:35:44Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Annals of Medicine |
| spelling | doaj.art-c78f439f344146dcb3d96950828eda1d2024-01-16T19:13:20ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602023-12-0155161562310.1080/07853890.2023.2178669Outcome of transcatheter atrial septal defect closure in a nationwide cohortV. Muroke0M. Jalanko1J. Haukka2J. Hartikainen3A. Tahvanainen4H. Ukkonen5K. Ylitalo6J. Pihkala7J. Sinisalo8Department of Cardiology, Helsinki University Hospital, Helsinki, FinlandDepartment of Cardiology, Helsinki University Hospital, Helsinki, FinlandDepartment of Public Health, University of Helsinki, Helsinki, FinlandDepartment of Cardiology, Kuopio University Hospital, Kuopio, FinlandDepartment of Cardiology, Tampere University Hospital, Tampere, FinlandHeart Centre, Turku University Hospital, Turku, FinlandDepartment of Cardiology, Oulu University Hospital, Oulu, FinlandDepartment of Cardiology, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, FinlandDepartment of Cardiology, Helsinki University Hospital, Helsinki, FinlandAbstractBackground Transcatheter (TC) atrial septal defect (ASD) closure has been the mainstay of therapy for secundum-type ASDs for over 20 years.Aims This nationwide cohort evaluated the long-term outcome of transcatheter-closed ASDs.Methods The study enrolled every transcatheter ASD closure performed in Finland from 1999 to 2019. Five age, sex, and municipality-matched controls per ASD patient were gathered from the general population. The median follow-up period was 5.9 years (range 0–20.8). We used the hospital discharge register to gather all hospital visits and diagnoses. Closure complications and echocardiographic changes were collected from the electronic health records.Results Transcatheter ASD closure was performed in 1000 patients (68.5% females) during the study period. The median (range) age at the time of the procedure was 37.9 (1.8–87.5) years. ASD patients had an increased risk for new-onset atrial fibrillation (RR 2.45, 95% CI: 1.84–3.25), migraine (RR 3.61, 95% CI: 2.54–5.14), ischemic heart disease (RR 1.73, 95% CI: 1.23–2.45), ventricular fibrillation/tachycardia (RR 3.54 (95% CI: 1.48–8.43) and AV conduction disorder (RR 3.60, 95% CI: 1.94–6.70) compared to the control cohort. Stroke risk was not increased (RR 1.36, 95% CI: 0.91–2.03). Adverse events occurred in 6.3% (n = 63) of the patients, including four erosions and ten device embolizations.Conclusion After TC closure of ASD, patients had a higher risk of new-onset atrial fibrillation and migraine than controls without ASD. As novel findings, we found an increased risk for ischemic heart disease, AV conduction disorders, and ventricular fibrillation/tachycardia.Key messagesEven though patients have an excellent overall prognosis after percutaneous ASD closure, the increased incidence of major comorbidities like atrial fibrillation and heart failure prompts more thorough lifelong follow-up.This study’s novel findings revealed the increased risk for ischemic heart disease, AV conduction disorders, or ventricular tachycardia/fibrillation during the follow-up.Major complications after the closure are rare; erosion is seen in 0.4% of the patients and embolization in 1.0% of the patients.https://www.tandfonline.com/doi/10.1080/07853890.2023.2178669Atrial septal defectcongenital heart diseaseatrial fibrillationstrokemigrainecomplication |
| spellingShingle | V. Muroke M. Jalanko J. Haukka J. Hartikainen A. Tahvanainen H. Ukkonen K. Ylitalo J. Pihkala J. Sinisalo Outcome of transcatheter atrial septal defect closure in a nationwide cohort Annals of Medicine Atrial septal defect congenital heart disease atrial fibrillation stroke migraine complication |
| title | Outcome of transcatheter atrial septal defect closure in a nationwide cohort |
| title_full | Outcome of transcatheter atrial septal defect closure in a nationwide cohort |
| title_fullStr | Outcome of transcatheter atrial septal defect closure in a nationwide cohort |
| title_full_unstemmed | Outcome of transcatheter atrial septal defect closure in a nationwide cohort |
| title_short | Outcome of transcatheter atrial septal defect closure in a nationwide cohort |
| title_sort | outcome of transcatheter atrial septal defect closure in a nationwide cohort |
| topic | Atrial septal defect congenital heart disease atrial fibrillation stroke migraine complication |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2023.2178669 |
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