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Original research
Atrial fibrillation in patients with an atrial septal defect in a single centre cohort during a long clinical follow-up: its association with closure and outcome of therapy
  1. Reinder Evertz1,
  2. Manon Reinders1,
  3. Charlotte Houck2,
  4. Tim ten Cate1,
  5. Anthonie L. Duijnhouwer1,
  6. Rypko Beukema1,
  7. Sjoerd Westra1,
  8. Kevin Vernooy3 and
  9. Natasja M S de Groot2
  1. 1Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
  2. 2Cardiology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
  3. 3Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
  1. Correspondence to Dr Reinder Evertz; reinder.evertz{at}


Objective Currently, consensus is lacking on the relation between closure of atrial septal defect (ASD) and the incidence of atrial fibrillation (AF), which is a known complication in ASD patients. More importantly, studies reporting on the treatment applied for AF in ASD patients are scarce. The aims of this study were (1) to assess the incidence of AF in ASD patients, (2) to study the relation between closure and AF and (3) to evaluate applied treatment strategies.

Methods A single-centre retrospective study in 173 patients with an ASD was performed. We analysed the incidence of AF, the relation of AF with closure, method of closure and the treatment success of therapies applied.

Results Almost 20% of patients with an ASD developed AF, with a mean age of 59 (±14) years at first presentation of AF during a median clinical follow-up of 43 (29–59) years. Older age (OR 1.072; p<0.001) and a dilated left atrium (OR 3.727; p=0.009) were independently associated with new-onset AF. Closure itself was not independently associated with AF. First applied treatment strategy was rhythm control in 77%. Of the 18 patients treated with antiarrhythmic drugs 50% had at least 1 recurrence of AF.

Conclusion No clear relation between closure of the ASD and AF could be assessed. This is the first study describing applied therapy for AF in ASD patients of which medical rhythm control was the most applied strategy with a disappointing efficacy.

  • atrial fibrillation
  • congenital heart disease
  • cardiac surgery

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  • RE and MR contributed equally.

  • Contributors RE and MR contributed equally to this paper. All authors contributed to the data analysis, drafting and revising the article and gave their approval for the final version to be published. They all take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This retrospective cohort study was approved by the local ethics committee in the Radboud University Medical Centre Nijmegen (METC number 2018–4861).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplementary information. The data have been stored at the hospital server.

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