Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure

被引:110
作者
Nyboe, C. [1 ,2 ]
Olsen, M. S. [2 ]
Nielsen-Kudsk, J. E. [3 ]
Hjortdal, V. E. [1 ]
机构
[1] Aarhus Univ Hosp, Dept Cardiothorac Surg, DK-8200 Aarhus N, Denmark
[2] Aarhus Univ Hosp, Dept Clin Epidemiol, DK-8200 Aarhus N, Denmark
[3] Aarhus Univ Hosp, Dept Cardiol, DK-8200 Aarhus N, Denmark
关键词
FOLLOW-UP; SURGICAL CLOSURE; RISK; PREVALENCE; REGISTRY; FLUTTER; REPAIR;
D O I
10.1136/heartjnl-2014-306552
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To estimate the risk of atrial fibrillation (AF) and stroke and the impact of closure in patients with atrial septal defect (ASD) compared with a general population cohort. Methods All adult Danish patients (>18 years) diagnosed with ASD from 1977 to 2009 (N=1168) were identified through population-based registries. Using Cox regression, we compared ASD patients' risk of AF and stroke with an age-matched and gender-matched comparison cohort. We computed prevalence proportions of anticoagulation and antiarrhythmic medicine use before and after closure and described stroke-related mortality. Results Median follow-up was 9.6 years (range 1-33 years). Patients with ASD had a higher risk of first-time AF (adjusted HR 8.2; 95% CI 6.6 to 10.2) after closure than the comparison cohort, but with no difference between transcatheter and surgical closure (HR 1.5, 95% CI 0.6 to 3.5). Patients without prevalent AF had a 10-year cumulative incidence of AF of 11% (95% CI 9% to 14%) after closure compared with 2% (95% CI 1.8% to 2.5%) in the comparison cohort. Patients with ASD with prevalent AF continued to use anticoagulation medicine after closure/diagnosis. Patients with ASD had increased risk of stroke without closure (adjusted HR 2.6; 95% CI 1.4 to 3.0) and with closure (adjusted HR 2.0; 95% CI 1.4 to 2.7). Risk of stroke after closure was related to AF (HR adjusted for AF 1.3; 95% CI 0.9 to 1.9). Conclusions Patients with ASD had a higher risk of first-time AF after closure than the comparison cohort. There was no effect of closure on the use of AF-related medicine in patients with prevalent AF.
引用
收藏
页码:706 / 711
页数:6
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