Atrial flutter/fibrillation in patients receiving transcatheter closure of atrial septal defect
Journal
Journal of the Formosan Medical Association
Journal Volume
116
Journal Issue
7
Pages
522-528
Date Issued
2017
Abstract
Background/purpose Atrial flutter/fibrillation (AFL/Af) is a common late complication in atrial septal defect (ASD) patients even after occluder implantation. We try to delineate the risk factors of persistent AFL/Af. Methods From 1998 to 2010, all patients older than 18 years of age who received ASD occluder implantation in our hospital were enrolled, and their records were retrospectively reviewed. In addition, renin–angiotensin system gene polymorphisms including angiotensinogen gene, A1166C polymorphism on the angiotensin II type I receptor gene, and insertion/deletion (I/D) patterns on the angiotensin-converting enzyme gene were checked using direct sequencing. Results A total of 517 patients (male/female 127/390) were enrolled. The mean age of patients receiving occluder deployment was 41.5 ± 14.5 years. Prior to occluder deployment, 3.9% of patients had persistent Af, 3.1% of patients had paroxysmal Af, and 0.8% had AFL. After a follow-up of 1894 patient-years, 3.5% had persistent Af and 1.9% of patients had paroxysmal Af. The greatest risk factors of AFL/Af genesis included age, occluder size, presence of multiple ASDs, and underlying thyroid or mitral valve disorder (p < 0.001, p < 0.001, p = 0.033, p = 0.016, and p = 0.012, respectively). Preoperative AFL/Af status is the most important factor in determining AFL/Af resolution and progression after an intervention. The renin–angiotensin system gene polymorphisms had no association with AFL/Af genesis, and progression or resolution after intervention. Conclusion AFL/Af is common after ASD occluder implantation, and predisposed by older age, larger and multiple ASDs, and underlying disorders. Preoperative atrial arrhythmia status is the most important predictor of AFL/Af progression or resolution. Renin–angiotensin system gene polymorphisms had no association with AFL/Af. ? 2016
SDGs
Other Subjects
adult; age; angiotensin converting enzyme gene; angiotensin II type 1 receptor gene; angiotensinogen gene; Article; atrial fibrillation; atrial septal occluder; cohort analysis; disease predisposition; female; follow up; gene; gene frequency; gene sequence; genetic polymorphism; haplotype; heart atrium arrhythmia; heart atrium flutter; heart atrium septum defect; heart catheterization; human; indel mutation; major clinical study; male; mitral valve disease; receptor gene; renin angiotensin aldosterone system; retrospective study; risk factor; thyroid disease; atrial fibrillation; complication; genetics; heart atrium flutter; heart catheterization; heart septum defect; middle aged; septal occluder; angiotensin 2 receptor; dipeptidyl carboxypeptidase; Adult; Atrial Fibrillation; Atrial Flutter; Cardiac Catheterization; Female; Heart Septal Defects, Atrial; Humans; Male; Middle Aged; Peptidyl-Dipeptidase A; Receptor, Angiotensin, Type 2; Septal Occluder Device
Publisher
Elsevier B.V.
Type
journal article