Correra Adriana, Mauriello Alfredo, Di Peppo Matilde, D'Andrea Antonello, Russo Vincenzo, Esposito Giovanni, Brunetti Natale Daniele
Cardiology Unit, Department of Cardiology, University of Foggia, 71122 Foggia, Italy.
Division of Cardiology, Institute National Cancer-IRCCS-Foundation "G. Pascale", 80131 Napoli, Italy.
Biomedicines. 2025 Oct 4;13(10):2427. doi: 10.3390/biomedicines13102427.
An atrial septal defect (ASD) is the most common congenital heart defect (CHD) diagnosed in adulthood. It is characterized by significant anatomical heterogeneity and complications that evolve over time. While often asymptomatic in children, the signs of adverse effects of ASD increase with age, including a greater risk of heart failure, stroke, atrial fibrillation (AF), and reduced life expectancy. ASD is traditionally considered a right-heart lesion due to long-term complications such as arrhythmias, right-sided heart failure, thromboembolism, and, in a subset of patients, pulmonary arterial hypertension (PAH). The pathophysiology of atrial shunts also affects the left heart due to volume overload and adverse ventriculo-ventricular interaction. Early diagnosis of interatrial septal anomalies is essential to prevent hemodynamic consequences and/or thromboembolic events. Electrocardiographic (ECG) findings play a crucial role in this early diagnosis. This narrative review aims to update clinicians on the latest evidence regarding the pathophysiological link between ASD and cardiac rhythm disorders, the nuances of optimal diagnostics, treatment options (surgical, interventional, pharmacological), and the need for long-term follow-up for patients with ASD. The review will determine the risk of conduction disorders compared to a healthy population and to compare the prevalences of conduction disorders, mortality, and pacemaker use in patients with closed ASDs versus those with open ASDs.
房间隔缺损（ASD）是成年期诊断出的最常见先天性心脏病（CHD）。其特点是存在显著的解剖学异质性以及随时间演变的并发症。虽然在儿童期通常无症状，但ASD不良反应的迹象会随着年龄增长而增加，包括心力衰竭、中风、心房颤动（AF）的风险更高以及预期寿命缩短。由于心律失常、右心衰竭、血栓栓塞等长期并发症，以及部分患者会出现肺动脉高压（PAH），ASD传统上被认为是一种右心病变。房水平分流的病理生理学也会因容量负荷过重和不良的心室间相互作用而影响左心。房间隔异常的早期诊断对于预防血液动力学后果和/或血栓栓塞事件至关重要。心电图（ECG）结果在这一早期诊断中起着关键作用。本叙述性综述旨在向临床医生更新关于ASD与心律失常之间病理生理联系的最新证据、最佳诊断的细微差别、治疗选择（手术、介入、药物）以及ASD患者长期随访的必要性。该综述将确定与健康人群相比传导障碍的风险，并比较闭合性ASD患者与开放性ASD患者的传导障碍患病率、死亡率和起搏器使用情况。
