Closure of atrial septal defects insufficient for cutting atrial arrhythmia prevalence

The percutaneous closure of atrial septal defects (ASDs) does not seem to reduce the prevalence of atrial arrhythmias, reports a new meta-analysis.

Drawing from the online databases of Medline, Embase, and the Cochrane Library, researchers identified 25 eligible studies that looked at the prevalence rates of all atrial arrhythmias and atrial fibrillation (AF) alone following ASD closure. Only studies on an adult population (≥18 years of age at enrolment) were eligible, while those that did not differentiate between ASD types were excluded.

Overall, a total of 3,587 patients undergoing percutaneous ASD closure were included in the pooled sample, of whom 612 had pre-procedure atrial arrhythmia.

Meta-analysis of all included studies showed that the closure of ASD had no significant impact on the prevalence of atrial arrhythmia (odds ratio [OR], 0.855, 95 percent confidence interval [CI], 0.672–1.087; p=0.201). At the same time, no clear effects on AF alone were documented after closure (OR, 0.818, 95 percent CI, 0.645–1.038; p=0.099).

However, the researchers saw signals of an age-dependent effect upon subgroup analysis. In patients ≥40 years of age at ASD closure, the procedure led to a significant reduction in the prevalence of both atrial arrhythmias (OR, 0.77, 95 percent CI, 0.616–0.919; p=0.032) and AF alone (OR, 0.760, 95 percent CI, 0.6–0.964; p=0.024), with low heterogeneity of evidence.

This age effect was attenuated when subgroup analysis was further refined to target patients ≥60 years at closure (atrial arrhythmia: OR, 0.822, 95 percent CI, 0.593–1.141; p=0.242; AF alone: OR, 0.83, 95 percent CI, 0.598–1.152; p=0.266). Data were insufficient for analysis of participants <40 years of age.

Despite a potential age interaction, post-hoc univariate meta-regression found that participant age failed to demonstrate a significant correlation with either atrial arrhythmia (p=0.46) or AF alone (p=0.97) prevalence after closure.