O'Neill Louisa, Floyd Christopher N, Sim Iain, Whitaker John, Mukherjee Rahul, O'Hare Daniel, Gatzoulis Michael, Frigiola Alessandra, O'Neill Mark D, Williams Steven E
King's College London, London, United Kingdom.
King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Int J Cardiol. 2020 Dec 15;321:104-112. doi: 10.1016/j.ijcard.2020.07.014. Epub 2020 Jul 15.
Atrial arrhythmias are common in patients with atrial septal defects (ASD) but the effects of percutaneous closure on atrial arrhythmia prevalence is unclear. We investigated the effects of ASD device closure and the impact of age at time of closure on prevalent atrial arrythmia.
Meta-analysis of studies reporting atrial arrhythmia prevalence in adult patients before and after percutaneous closure was performed. Primary outcomes were prevalence of 'all atrial arrhythmia' and atrial fibrillation alone post closure. Sub-group analysis examined the effects of closure according to age in patients; <40 years, ≥40 and ≥ 60 years. 25 studies were included.
Meta-analysis of all studies demonstrated no reduction in all atrial arrhythmia or atrial fibrillation prevalence post-closure (OR 0.855, 95% CI 0.672 to 1.087, P = .201 and OR 0.818, 95% CI 0.645 to 1.038, P = .099, respectively). A weak reduction in all atrial arrhythmia and atrial fibrillation was seen in patients ≥40 years (OR 0.77, 95% CI 0.616 to 0.979, P = .032 and OR 0.760, 95% CI 0.6 to 0.964, P = .024, respectively) but not ≥60 years (OR 0.822, 95% CI 0.593 to 1.141, P = .242 and OR 0.83, 95% CI 0.598 to 1.152, P = .266, respectively). No data were available in patients <40 years. This, and other limitations, prevents conclusive assessment of the effect of age on arrhythmia prevalence.
Overall, percutaneous ASD closure is not associated with a reduction in atrial arrhythmia prevalence in this meta-analysis. A weak benefit is seen in patients ≥40 years of age, not present in patients ≥60 years.
房间隔缺损（ASD）患者中房性心律失常很常见，但经皮封堵对房性心律失常患病率的影响尚不清楚。我们研究了ASD装置封堵的效果以及封堵时年龄对房性心律失常患病率的影响。
对报告成年患者经皮封堵前后房性心律失常患病率的研究进行荟萃分析。主要结局是封堵后“所有房性心律失常”和单独房颤的患病率。亚组分析根据患者年龄（<40岁、≥40岁和≥60岁）检查封堵效果。纳入了25项研究。
所有研究的荟萃分析表明，封堵后所有房性心律失常或房颤患病率均未降低（OR=0.855，95%CI为0.672至1.087，P=0.201；OR=0.818，95%CI为0.645至1.038，P=0.099）。≥40岁患者的所有房性心律失常和房颤患病率略有降低（OR=0.77，95%CI为0.616至0.979，P=0.032；OR=0.760，95%CI为0.6至0.964，P=0.024），但≥60岁患者未降低（OR=0.822，95%CI为0.593至1.141，P=0.242；OR=0.83，95%CI为0.598至1.152，P=0.266）。<40岁患者没有可用数据。这一点以及其他局限性妨碍了对年龄对心律失常患病率影响的确定性评估。
总体而言，在这项荟萃分析中，经皮ASD封堵与房性心律失常患病率降低无关。≥40岁患者有微弱益处，≥60岁患者则没有。
