Arrhythmic Risk and Treatment after Transcatheter Atrial Septal Defect Closure

Area of Science:

• Cardiology
• Congenital Heart Disease
• Electrophysiology

Background:

• Atrial septal defect (ASD) is the most prevalent adult congenital heart defect.
• Intracardiac shunts cause atrial and ventricular remodeling, increasing arrhythmia risk, particularly atrial fibrillation (AF).
• Mechanisms of arrhythmia are complex, partly independent of hemodynamic overload.

Purpose of the Study:

• To review predictors of atrial arrhythmias after ASD closure.
• To discuss the impact of device closure and timing on arrhythmia risk.
• To highlight sudden cardiac death (SCD) risk and implantable cardioverter-defibrillator (ICD) indications.

Main Methods:

• Review of clinical, echocardiographic, and electrocardiogram predictors.
• Assessment of device-related factors influencing arrhythmia risk.
• Evaluation of mechanisms underlying arrhythmias post-ASD closure.

Main Results:

• Clinical and device-related factors predict atrial arrhythmias post-closure.
• ASD closure and its timing influence future arrhythmia risk.
• Transseptal puncture post-closure presents procedural challenges.

Conclusions:

• Risk stratification for arrhythmias after ASD closure is crucial.
• Understanding complex underlying mechanisms is essential for management.
• Selected patients may benefit from ICD implantation due to elevated SCD risk.