Related Experiment Video
Updated: Jan 27, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Closure of secundum atrial septal defect and risk of incident and recurrent arrhythmia
Eva Havers-Borgersen1, Michael Rahbek Schmidt2, Jakob Schrøder2
1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
Insights
Atrial septal defect (ASD) closure impacts arrhythmia risk. Percutaneous closure may decrease recurrence, while surgical closure increases arrhythmia risk compared to no closure.
Area of Science:
- Cardiology
- Cardiac Surgery
- Public Health
Background:
- Atrial septal defect (ASD) is a common congenital heart defect.
- ASD can lead to significant morbidity, particularly arrhythmias.
- Limited data exists on the long-term effects of ASD closure on arrhythmia risk.
Purpose of the Study:
- To investigate the impact of atrial septal defect closure on arrhythmia incidence and recurrence.
- To analyze the influence of closure timing and technique on arrhythmia risk.
- To provide data on the long-term outcomes of ASD management.
Main Methods:
- Danish nationwide cohort study of secundum ASD patients (1977-2024).
- Follow-up until arrhythmia, death, emigration, or study end (Jan 2024).
- Risk assessment of arrhythmias based on ASD closure status and technique (surgical vs. percutaneous).
Main Results:
- 34.6% of 6,469 ASD patients underwent closure (65.5% surgical, 34.5% percutaneous).
- Arrhythmia incidence was 13.3 per 1,000 PY; atrial fibrillation/flutter was most common.
- Surgical closure correlated with increased arrhythmia risk (aHR 1.38), while percutaneous closure showed no difference versus no closure.
- Percutaneous closure was linked to decreased recurrence risk (aHR 0.79).
Conclusions:
- Arrhythmia incidence in ASD patients is significant, influenced by age and closure method.
- Surgical ASD closure is associated with a higher risk of arrhythmias.
- Percutaneous closure may reduce arrhythmia recurrence in ASD patients.
Background:
Atrial septal defect (ASD) is a simple defect but carries considerable morbidity, especially arrhythmias.
Objectives:
Data on the impact and timing of ASD closure and the risk of (recurrent) arrhythmia remain scarce and will be the focus of this study.
Methods:
This Danish nationwide cohort study included all patients diagnosed with secundum ASD (1977-2024), followed until arrhythmia, death, emigration, or study end (January 2024). The risk of (recurrent) arrhythmias was assessed based on ASD closure status and closure technique.
Results:
Among 6469 patients with ASD (43.3% men), 34.6% underwent ASD closure (65.5% surgically and 34.5% percutaneously). The incidence rate of arrhythmia was 13.3 (95% confidence interval [CI], 12.6-14.2) per 1000 person-years (PY), with atrial fibrillation/flutter being the most prevalent. Older age at diagnosis and closure were linked to higher incidence and recurrence of arrhythmia. In time-dependent Cox regression analyses, surgical ASD closure was associated with an increased risk of arrhythmias compared withwith no closure (adjusted hazard ratio [HR], 1.38 [95% CI, 1.19-1.60]), whereas no difference was found for percutaneous closure. Overall, 3 in 4 patients experienced arrhythmia recurrence. ASD closure was associated with a decreased risk of recurrence; however, statistical significance was observed only when comparing percutaneous closure to no closure (adjusted HR, 0.79 [95% CI, 0.64-0.98]).
Conclusion:
The incidence rate of arrhythmia among patients with ASD was 13 per 1000 PY, with age and closure technique being pivotal factors. Surgical closure was associated with an increased risk of arrhythmias compared with no closure, whereas percutaneous closure was associated with a decreased risk of recurrence.
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