Fate of preoperative atrial fibrillation after correction of atrial septal defect

Abstract

Background: Atrial fibrillation (AF) is common among adult patients with an atrial septal defect (ASD). Catheter ablation or the Maze procedure can be considered for AF before or concurrently with ASD closure. However, the fate of preoperative AF is not well established. This study examined the postoperative course of patients with AF before undergoing ASD correction.

Methods and results: The 471 patients (131 men, 42 ± 14 years) underwent transcatheter closure (n=237, 50%) or surgical repair (n=234, 50%) of an ASD. ECG and Holter monitoring were used to document preoperative and postoperative AF. Forty patients had AF before transcatheter closure (n=10) or surgical repair (n=30) of the ASD. During the follow-up period of 44 ± 28 months, excluding 15 patients who had undergone surgical repair with the Maze procedure, sinus rhythm (SR) was maintained in 7 (88%) of 8 patients with paroxysmal AF. However, only 3 (18%) of 17 patients with persistent AF maintained SR. Among the 15 patients treated with the Maze procedure, 12 (80%) maintained SR.

Conclusions: Hemodynamic correction of ASD was effective in conversion to SR in most patients with preoperative paroxysmal AF. However, the Maze procedure or transcatheter ablation before ASD correction needs to be considered for the treatment of AF in patients with persistent AF.