Atrial Septal Defect and Heart Rhythm Disorders: Physiopathological Linkage and Clinical Perspectives

Area of Science:

• Cardiology
• Congenital Heart Disease
• Electrophysiology

Background:

• Atrial septal defect (ASD) is the most frequent congenital heart defect (CHD) diagnosed in adulthood.
• ASD presents significant anatomical variability and evolving complications, with risks like heart failure, stroke, and atrial fibrillation increasing with age.
• While primarily affecting the right heart, ASD pathophysiology also impacts the left heart through volume overload and ventricular interaction.

Purpose of the Study:

• To provide clinicians with an updated review on the relationship between ASD and cardiac rhythm disorders.
• To discuss optimal diagnostic strategies, including the role of electrocardiography (ECG).
• To evaluate treatment options (surgical, interventional, pharmacological) and the necessity of long-term patient follow-up.

Main Methods:

• This narrative review synthesizes current evidence on ASD pathophysiology, diagnosis, and management.
• It specifically examines the link between ASD and cardiac rhythm disorders.
• The review compares conduction disorder risks, mortality, and pacemaker use between patients with closed versus open ASDs and a healthy population.

Main Results:

• Early diagnosis of interatrial septal anomalies is vital to prevent hemodynamic compromise and thromboembolic events.
• ECG findings are critical for the early detection of ASD.
• The review aims to quantify the risk of conduction disorders and compare outcomes in patients with treated versus untreated ASDs.

Conclusions:

• ASD management requires a comprehensive approach, integrating diagnostics, timely intervention, and ongoing monitoring.
• Understanding the pathophysiological links between ASD and arrhythmias is key to optimizing patient care.
• Long-term follow-up is essential for patients with ASD to manage potential complications and improve life expectancy.