Dual-Phase Increase in Atrial Arrhythmia Prevalence Following Percutaneous Atrial Septal Defect Closure.

Background: Conflicting data surround the relationship between age at percutaneous atrial septal defect (ASD) closure and subsequent burden of atrial arrhythmias (AA), particularly in adults. This study aimed to determine the effect of age at ASD closure and other predisposing patient-specific factors on the burden of AA postpercutaneous ASD closure. Methods: All patients who underwent percutaneous ASD closure at Cleveland Clinic from January 2010 to July 2022 were included. A nonlinear logistic temporal decomposition mixed-effects model was used to analyze the longitudinal AA. Results: Among 197 patients, 63% (125) were female, with a mean age of 40 years (SD, 24 years) at ASD closure. A total of 177 patients (89% of the cohort) had 687 rhythm records. Postclosure AA exhibited a dual-phase pattern: early peaking phase followed by a late rise up to 6 years postclosure. Age 60 years or older was associated with higher likelihood of early (≤6 months) and late (>6 months) AA prevalence. Older age, lower E/A ratio, and lower left ventricular ejection fraction were associated with a higher likelihood of AA post-ASD closure. Greater than moderate tricuspid regurgitation was associated with a higher likelihood of early AA. Mild right ventricular dysfunction and more than moderate right ventricular dilation were associated with a higher likelihood of late AA. Conclusions: Older patients have an ongoing dual-phase risk for AA postpercutaneous ASD closure. Our findings underscore the need for routine rhythm monitoring in patients aged 60 years or older.