Impaired Left Atrial Function in Patients with Atrial Septal Defect and History of Atrial Fibrillation A Multicenter Retrospective Cohort Study

Manabu Nitta, Makoto Kaneko, Sayuri Shimizu, Hideaki Kanazawa, Yuji Itabashi, Kotaro Miura, Mike Saji, Itaru Takamisawa, Morimasa Takayama, Shintaro Nakano, Saki Hasegawa-Tamba, Shinichiro Ueda

Research output: Contribution to journalArticlepeer-review

Abstract

In patients with atrial septal defect (ASD), atrial left-to-right shunting causes left atrial (LA) remodeling and dysfunction, leading to atrial fibrillation (AF). In adults with ASD and concomitant AF, LA function should be evaluated after ASD closure plus AF radiofrequency catheter ablation (RFCA). This multicenter retrospective cohort study included patients who underwent transcatheter ASD closure at one of the four leading hospitals. Patients with a history of AF also underwent preceding RFCA. The association between AF history and LA ejection fraction (EF) (indicating LA global function) at 6-12 months following ASD closure was evaluated. To account for differences in baseline characteristics between patients with and without a history of AF, we conducted the following statistical methods: (1) multivariate regression analysis in the prepropensity score (PS)-matched cohort and (2) univariate comparisons in the PS-matched cohort. Overall, this study included 231 patients (30 with AF history, 201 without). Multiple regression analysis showed that AF history was independently associated with impaired LAEF (β = −10.425, P < 0.001, model created prior to propensity matching). A one-to-one PS matching (25 pairs) showed that the LAEF at 6-12 months following ASD closure was significantly impaired in patients with ASD and AF history compared to that in patients without history of AF (median LAEF, 37.5% (interquartile range [IQR] 29.4%-48.5%) versus 52.3 [IQR 50.0%-56.6%]; P < 0.001). LA function was impaired in patients with ASD and a history of AF at 6-12 months after successful transcatheter ASD closure and on maintenance of sinus rhythm by RFCA.

Original languageEnglish
Pages (from-to)864-873
Number of pages10
JournalInternational Heart Journal
Volume63
Issue number5
DOIs
Publication statusPublished - 2022

Keywords

  • Atrial arrhythmia
  • Catheter ablation
  • Congenital heart disease
  • Left atrial ejection fraction
  • Transcatheter atrial septal defect closure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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