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Updated: Jan 18, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Dual-Phase Increase in Atrial Arrhythmia Prevalence Following Percutaneous Atrial Septal Defect Closure
Brendan J Burke1, Ghazaleh Goldar2,3, Jeevanantham Rajeswaran4
1Children's Institute, Division of Cardiology and Cardiovascular Medicine, Department of Heart, Vascular and Thoracic, Cleveland Clinic Children's, Cleveland, Ohio.
Insights
Older adults undergoing percutaneous atrial septal defect (ASD) closure face a dual-phase risk of atrial arrhythmias (AA) post-procedure. Routine rhythm monitoring is recommended for patients aged 60 and above.
Area of Science:
- Cardiology
- Electrophysiology
- Adult Congenital Heart Disease
Background:
- Conflicting data exist regarding age at percutaneous atrial septal defect (ASD) closure and subsequent atrial arrhythmias (AA) burden in adults.
- Predisposing patient-specific factors influencing AA post-ASD closure require further investigation.
Purpose of the Study:
- To determine the effect of age at ASD closure on the burden of AA post-procedure.
- To identify patient-specific factors associated with AA development after percutaneous ASD closure.
Main Methods:
- Analysis of 197 patients who underwent percutaneous ASD closure between January 2010 and July 2022.
- Utilized a nonlinear logistic temporal decomposition mixed-effects model to analyze longitudinal AA data.
- Included patient demographics, echocardiographic parameters, and rhythm monitoring records.
Main Results:
- Postclosure AA exhibited a dual-phase pattern: early peaking and a late rise up to 6 years.
- Age 60 years or older was linked to higher early and late AA prevalence.
- Older age, lower E/A ratio, lower ejection fraction, tricuspid regurgitation, RV dysfunction, and RV dilation were associated with increased AA likelihood.
Conclusions:
- Older patients experience an ongoing dual-phase risk for AA after percutaneous ASD closure.
- Routine rhythm monitoring is crucial for patients aged 60 years and older post-ASD closure.
Background:
Conflicting data surround the relationship between age at percutaneous atrial septal defect (ASD) closure and subsequent burden of atrial arrhythmias (AA), particularly in adults. This study aimed to determine the effect of age at ASD closure and other predisposing patient-specific factors on the burden of AA postpercutaneous ASD closure.
Methods:
All patients who underwent percutaneous ASD closure at Cleveland Clinic from January 2010 to July 2022 were included. A nonlinear logistic temporal decomposition mixed-effects model was used to analyze the longitudinal AA.
Results:
Among 197 patients, 63% (125) were female, with a mean age of 40 years (SD, 24 years) at ASD closure. A total of 177 patients (89% of the cohort) had 687 rhythm records. Postclosure AA exhibited a dual-phase pattern: early peaking phase followed by a late rise up to 6 years postclosure. Age 60 years or older was associated with higher likelihood of early (≤6 months) and late (>6 months) AA prevalence. Older age, lower E/A ratio, and lower left ventricular ejection fraction were associated with a higher likelihood of AA post-ASD closure. Greater than moderate tricuspid regurgitation was associated with a higher likelihood of early AA. Mild right ventricular dysfunction and more than moderate right ventricular dilation were associated with a higher likelihood of late AA.
Conclusions:
Older patients have an ongoing dual-phase risk for AA postpercutaneous ASD closure. Our findings underscore the need for routine rhythm monitoring in patients aged 60 years or older.
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