Original Article
Atrial Arrhythmia after Surgical Closure of Atrial Septal Defects in Adults
N Engl J Med 1999; 340:839-846March 18, 1999
- Abstract
Background
Atrial flutter and atrial fibrillation are causes of morbidity in adults with an atrial septal defect. In this study, we attempted to identify risk factors for atrial flutter and fibrillation both before and after the surgical closure of an atrial septal defect.
Methods
We searched for preoperative and postoperative atrial flutter or fibrillation in 213 adult patients (82 men and 131 women) who underwent surgical closure of atrial septal defects because of symptoms, a substantial left-to-right shunt (ratio of pulmonary to systemic blood flow, >1.5:1), or both at Toronto Hospital between 1986 and 1997.
Results
Forty patients (19 percent) had sustained atrial flutter or fibrillation before surgery. As compared with the patients who did not have atrial flutter or fibrillation before surgery, those who did were older (mean [±SD] age, 59±11 vs. 37±13 years, P<0.001) and had higher mean pulmonary arterial pressures (25.0±9.7 vs. 19.7±8.2 mm Hg, P=0.001). There were no perioperative deaths. After a mean follow-up period of 3.8±2.5 years, 24 of the 40 patients (60 percent) continued to have atrial flutter or fibrillation. The mean age of these patients was greater than that of the 16 who converted to sinus rhythm (P=0.02). New-onset atrial flutter or atrial fibrillation was more likely to have developed at follow-up in patients who were older than 40 years at the time of surgery than in those who were 40 or younger (5 of 67 vs. 0 of 106, P=0.008). Late events (those occurring more than one month after surgery) included stroke in six patients (all but one with atrial flutter or fibrillation, one of whom died) and death from noncardiac causes in two patients. Multivariate analysis showed that older age (>40 years) at the time of surgery (P=0.001), the presence of preoperative atrial flutter or fibrillation (P<0.001), and the presence of postoperative atrial flutter or fibrillation or junctional rhythm (P=0.02) were predictive of late postoperative atrial flutter or fibrillation.
Conclusions
The risk of atrial flutter or atrial fibrillation in adults with atrial septal defects is related to the age at the time of surgical repair and the pulmonary arterial pressure. To reduce the morbidity associated with atrial flutter and fibrillation, the timely closure of atrial septal defects is warranted.
Media in This Article
Figure 1
Kaplan–Meier Estimates of Late Postoperative Atrial Flutter or Fibrillation.Table 1
Characteristics of the Patients.Article Activity
- Article
Atrial flutter and atrial fibrillation are well-documented sequelae of atrial septal defects, associated with substantial morbidity and, occasionally, death.1-3 The prevention of atrial flutter or fibrillation or the restoration of sinus rhythm in patients with these defects is therefore desirable. The surgical closure of atrial septal defects leads to improved functional status and reduces the risk of right-sided heart failure and progressive or severe pulmonary hypertension.1,4,5 Atrial flutter or fibrillation, however, has often persisted at late follow-up (>25 years) in patients who have undergone surgical closure after childhood (reported incidence, 41 to 59 percent).1,4-7
Evidence suggests that the Cox maze procedure,8 performed at the time of closure of an atrial septal defect, is feasible and is associated with good short-term and intermediate-term maintenance of sinus rhythm.9-11 This finding has led several groups to advocate the use of surgical procedures to target atrial flutter and fibrillation at the time of the surgical repair of an atrial septal defect in patients considered to be at high risk for these arrhythmias.9-12 However, advances in diagnostic and surgical techniques and new guidelines for the management of atrial fibrillation13 have altered the characteristics of patients with atrial septal defects referred for surgical closure and possibly their outcomes. Data are required to identify patients with atrial septal defects who are currently at risk for atrial flutter or fibrillation despite closure of the defect. We undertook this study to evaluate the incidence and predictors of atrial flutter or fibrillation and the associated outcomes of surgery to close an atrial septal defect in a contemporary cohort of adult patients.
Methods
Patients and Collection of Data
All patients who underwent surgical closure of atrial septal defects at Toronto Hospital between June 1986 and June 1997 were identified retrospectively from the hospital's cardiovascular surgical data base. The patients were referred for surgery by their cardiologists because they had symptoms, because they had a substantial left-to-right shunt (ratio of pulmonary to systemic blood flow [Qp:Qs], >1.5:1), or because they had both. We excluded patients with a persistent foramen ovale or a small atrial septal defect (without evidence of right ventricular volume overload) who were undergoing surgery for episodes of paradoxical embolism. Patients referred for reoperation of previously repaired atrial septal defects and those with complex congenital heart disease were also excluded. Finally, we excluded foreign patients because of the difficulty of obtaining follow-up information. Preoperative and perioperative data, including functional status, the nature of the atrial septal defect, whether cardiac catheterization had been performed, and surgical reports, were obtained from hospital records. The Qp:Qs ratio was determined by oximetry. All surgery was performed by means of cardiopulmonary bypass with the use of bicaval and ascending aortic cannulation. For myocardial protection, moderate systemic hypothermia was used in most cases, with cold potassium-enriched cardioplegia being used when a complicated patch repair was required.
Follow-up for all patients included in the study was conducted between September 1997 and January 1998 and consisted of evaluations at the Toronto Congenital Cardiac Centre for Adults, contact with the patients' physicians, and written questionnaires and telephone interviews with patients. The study protocol was approved by the Toronto Hospital Human Ethics Committee. The patients' physicians were asked to provide additional preoperative information, when such information was required. Information about postoperative death, cardiac rhythm, stroke, heart failure, functional status (as defined by the New York Heart Association [NYHA] classification), the need for reoperation, residual atrial septal defects, systemic hypertension, and type of medical therapy needed was obtained at the time of follow-up. The arrhythmia group comprised all patients presenting with documented sustained atrial flutter or fibrillation and associated symptoms. Patients who had asymptomatic, nonsustained episodes of atrial arrhythmia during Holter monitoring were not included in this group. We did not differentiate between chronic and paroxysmal atrial flutter or fibrillation.
We cross-classified patients according to the presence of atrial flutter or fibrillation before surgery and its presence at the latest follow-up visit after the first postoperative month (defined as late atrial flutter or fibrillation) as follows: group A had atrial flutter or fibrillation both before surgery and at the latest follow-up visit; group B had atrial flutter or fibrillation before surgery but no evidence of recurrence after surgery (i.e., the patient converted to and remained in sinus rhythm); group C was in sinus rhythm before surgery but had atrial flutter or fibrillation at the latest follow-up visit; and group D was in sinus rhythm both before surgery and at the latest follow-up visit.
Statistical Analysis
We analyzed the data using SPSS for Windows (version 7.0, SPSS, Chicago). Descriptive data for continuous variables are presented as means ±SD or as medians with ranges, when appropriate. Discrete variables were analyzed by chi-square or Fisher's exact tests. Continuous data were analyzed by the two-sample t-test or the Wilcoxon rank-sum test; they were analyzed across the four subgroups with the Kruskal–Wallis test. If the result of the Kruskal–Wallis test was significant (P<0.05), then pairwise comparisons (group A vs. group B and group C vs. group D) were performed with the Wilcoxon rank-sum test; for pairwise testing, the level of significance was adjusted for multiple comparisons (two-sided test, P<0.025). Linear regression analysis of the interaction between the age of the patient at the time of surgical repair and the pulmonary arterial pressure was performed.
The probability of remaining free of late atrial flutter or fibrillation over time was displayed with Kaplan–Meier plots. Univariate analysis of predictors of late atrial flutter or fibrillation was performed with the Cox proportional-hazards model. Univariate predictors with a significance level of <0.20 were entered into a multivariate Cox proportional-hazards model with the use of a backward-elimination algorithm.14 The level of significance for the multivariate model was set at 0.05. For the purpose of multivariate analysis, univariate predictors that were highly correlated with each other (those with a correlation coefficient of >0.70) were combined into a composite variable. A secondary analysis was performed with the subgroup of 149 patients for whom preoperative cardiac-catheterization data were available.
Results
Preoperative Data
Two hundred eighteen consecutive patients who underwent surgical closure of an isolated atrial septal defect fulfilled the criteria for inclusion in the study (Table 1Table 1
Characteristics of the Patients.). An additional 11 patients with a small atrial septal defect who were undergoing surgery for episodes of paradoxical embolism, 4 patients who had had previous repair of an atrial septal defect, and 5 foreign patients were excluded. We were unable to obtain follow-up data on five patients (2.3 percent); information from the provincial death registry indicated that they were alive in 1997. The remaining 213 patients (82 men and 131 women), who made up the study population, underwent closure of an atrial septal defect at a mean (±SD) age of 41±14 years (median, 40; range, 16 to 80). Of the patients referred for surgery by their physicians, 68 percent were referred because of symptoms (exertional dyspnea, with varying degrees of decreasing exercise capacity in 95 percent, heart failure in 3 percent, and presyncope or syncope in 2 percent), and the remaining patients were referred because they had a substantial left-to-right shunt (Qp:Qs, >1.5:1). The NYHA functional class was I or II in 70 percent of the patients, III in 29 percent, and IV in 0.5 percent. The diagnosis was established by echocardiography in 199 patients (93 percent) and at the time of cardiac catheterization in 14 patients. One hundred forty-nine patients (70 percent) underwent cardiac catheterization (Table 1), mainly so that pulmonary arterial pressure could be assessed and coexisting coronary artery disease could be identified. There was a weak correlation between age at the time of surgical repair and mean pulmonary arterial pressure (r=0.46, P<0.001), but not between the magnitude of the left-to-right shunt and mean pulmonary arterial pressure.Forty patients (19 percent) had documented sustained atrial flutter or fibrillation before surgery, with exertional dyspnea and decreasing exercise capacity in 32 of these patients, congestive heart failure in 5, and presyncope or syncope in 3. Twenty-one patients had chronic atrial flutter or fibrillation; the remainder had paroxysmal atrial flutter or fibrillation that required one or more electrical or pharmacologic cardioversions. Eleven of the 40 patients had atrial flutter, and 35 had atrial fibrillation (6 of these patients initially presented with atrial flutter but had atrial fibrillation before surgery) (Table 2Table 2
Preoperative Atrial Flutter or Fibrillation.).Thirty-nine of the 40 patients were receiving antiarrhythmic-drug therapy at the time of surgical repair. Thirty-three of these patients were taking digoxin, 24 of whom were taking it with other antiarrhythmic drugs. The patients who had atrial flutter or fibrillation were significantly older at the time of surgical repair and had a higher mean pulmonary arterial pressure than those who did not. The magnitude of the left-to-right shunt was similar in the two groups.
Perioperative Data
There were no perioperative deaths. Defects were repaired either by primary suture closure (53 percent) or by autologous pericardial patch (47 percent). Twenty-six patients underwent concomitant cardiac procedures (mitral-valve repair in 8, tricuspid-valve repair in 4, and coronary-artery bypass grafting in 14). The incidence of perioperative complications was 9 percent (pericarditis in 11 patients, bleeding requiring reoperation in 3, congestive heart failure in 2, and tamponade, transient ischemic attack, and deep venous thrombosis in 1 each).
Early postoperative arrhythmia (within 30 days after surgery) occurred in 46 patients (atrial fibrillation in 32, atrial flutter in 6, and junctional rhythm in 8) and was correlated with preoperative atrial flutter or fibrillation (P<0.001 by the chi-square test). Twelve of the 40 patients (30 percent) with preoperative atrial flutter or fibrillation had spontaneous conversions to normal sinus rhythm by the time they were discharged from the hospital, with no evidence of recurrence of atrial flutter or fibrillation thereafter. Three patients without atrial arrhythmias required insertion of a pacemaker, two for persistent sinus-node dysfunction and one for complete atrioventricular block.
Follow-up Data
Follow-up data are complete. At a mean duration of follow-up of 3.8±2.5 years from the time of surgical repair (median, 3 years; range, 0.5 to 10), all but three patients were alive. One patient (known to be in atrial fibrillation) died of stroke, and two died of cancer (one of lung cancer and the other of bladder cancer). Three patients underwent reoperation — one for residual atrial septal defect, one for mitral-valve replacement, and one for coronary-artery bypass. One hundred eighty-five patients (87 percent) had functional status of NYHA class I, and 28 (13 percent) had functional status of class II, indicating significant improvement from the preoperative status (P<0.001 by the chi-square test).
Twenty-four of the 40 patients (60 percent) with preoperative atrial flutter or fibrillation continued to have these arrhythmias at the latest follow-up visit (Figure 1Figure 1
Kaplan–Meier Estimates of Late Postoperative Atrial Flutter or Fibrillation. and Table 3Table 3
Atrial Flutter or Fibrillation at Follow-up.). All 24 were older than 40 years at the time of surgical repair, and their mean age was greater than that of the 16 patients who converted to sinus rhythm (P=0.02 by the Wilcoxon rank-sum test). In addition, atrial flutter or fibrillation developed in five other patients (all of whom were older than 40 years at the time of surgical repair) by the time the study concluded. All 29 patients with sustained atrial flutter or fibrillation at follow-up were receiving antiarrhythmic-drug therapy. Twenty-five were receiving digoxin, 17 of whom were also taking other antiarrhythmic drugs. For the patients in sinus rhythm preoperatively, those older than 40 years at the time of surgery had an 8 percent risk of late atrial flutter or fibrillation; in contrast, none of the 106 patients 40 years of age or younger at the time of surgery had late atrial arrhythmias (P=0.008 by Fisher's exact test).Six patients had strokes during the follow-up period, one of whom died (Table 4Table 4
Characteristics of the Six Patients Who Had Strokes after Surgical Closure of an Atrial Septal Defect.). The NYHA class of all but one improved after surgery. None of the patients had a residual atrial septal defect on echocardiography. Five were known to be in atrial flutter or fibrillation during the follow-up period. Before their strokes, three patients were receiving warfarin, and two were receiving aspirin. All but one were receiving antiarrhythmic-drug therapy. Four patients were receiving additional therapy — two for heart failure and two for systemic hypertension. An additional patient presented with stroke, presumably due to paradoxical embolism, before surgery. This patient had no further embolic episodes after the surgical closure of a large atrial septal defect.Predictors of Late Postoperative Atrial Flutter or Fibrillation
According to multivariate analysis, an age of more than 40 years at the time of surgical repair, the presence of preoperative and immediate postoperative (within 1 month after surgery) atrial flutter or fibrillation, and the presence of immediate postoperative junctional rhythm were independent predictors of persistent or new atrial flutter or fibrillation by the latest follow-up (Table 5Table 5
Predictors of Late Atrial Flutter or Fibrillation.). Secondary analysis in which data on cardiac catheterization were used did not yield additional predictors of late postoperative atrial flutter or fibrillation.Discussion
This study examined the incidence of and risk factors for atrial flutter or fibrillation in adult patients with atrial septal defects who were referred for surgery because they had symptoms, a substantial left-to-right shunt, or both. The findings of low perioperative morbidity, no perioperative mortality, and symptomatic improvement in most of the patients in this series are additional evidence of the beneficial role of surgery. The persistence or development of atrial arrhythmia after surgical repair and its association with important morbidity, however, calls for further modifications in the management of atrial septal defects diagnosed during adulthood.
The age of the patient at the time of the surgical repair of the atrial septal defect was the main predictor of persistent or new arrhythmia after surgery. The explanation for the strength of this prognostic variable is almost certainly multifactorial.15 Long-standing volume overload, varying degrees of pulmonary hypertension, and ventricular dysfunction have all been implicated in and may contribute to arrhythmogenesis. Atrial stretch,16 in response to volume overload, prolongs atrial refractoriness in a heterogeneous manner, making the atria vulnerable to the induction of fibrillation. Morillo et al.17 showed a strong correlation between an increase of 40 percent or more in atrial area and the inducibility of sustained atrial flutter or fibrillation.
Likewise, the persistence of atrial flutter or fibrillation in older patients, found in this and previous studies, may be the result of established enlargement or electrophysiologic derangement of the right atrial wall, which may not resolve completely with closure of the atrial septal defect. Diastolic properties of both ventricles may also be involved in arrhythmogenesis.18 The elevated pulmonary arterial wedge pressure in patients presenting with arrhythmia may be a reflection of increased left ventricular end-diastolic pressure. A “stiff” left ventricle has the potential to aggravate a preexisting left-to-right intracardiac shunt. Several mechanisms for reduced left ventricular compliance have been proposed, including ventricular–ventricular interaction,19 abnormal interventricular septal motion,20,21 and decreased left ventricular preload.22 Older age may be another contributing factor.
Our data suggest that the relative increase in pulmonary arterial pressure in adult patients with atrial septal defects may be the result of older age. Currently, most patients in whom atrial septal defect is diagnosed do not have pulmonary vascular disease severe enough to preclude closure. This change in patient profile may be due to advances in imaging, facilitating a relatively early diagnosis. Clearly, the risk of pulmonary hypertension in older adults is now lower than previously reported,2 and it is not one of the main reasons for recommending surgical closure of atrial septal defects in current practice.
In contrast, in this series, as in most previous studies,1-5,23 the development of symptoms during adulthood was common. Over two thirds of our patients became symptomatic at a mean age of 41 years. Most of them, including the older patients,7,23 improved clinically after surgery, as was demonstrated by changes in the NYHA class. Despite questions raised by Shah et al.24 and Ward25 regarding the prognosis of atrial septal defect in patients who have undergone surgical closure after childhood, the evidence is overwhelming that adult patients with this condition have improved functional status after surgery.1,4,5,7,23,26 The recent report by Helber et al.27 on cardiopulmonary testing confirms the previous clinical impression that exercise capacity is limited before the closure of an atrial septal defect in adulthood and improves thereafter. Helber et al. demonstrated restoration of cardiopulmonary function in adults with nonrestrictive atrial septal defects who underwent surgical closure at a mean age of 40 years.
It is a matter of concern that atrial flutter and fibrillation remain important causes of morbidity after surgery to repair an atrial septal defect in adulthood. It has been proposed that atrial flutter and fibrillation may be more responsive to drug therapy if surgery eliminates intracardiac shunting and if the size of the right atrium decreases.15 However, atrial flutter and fibrillation remain problematic, primarily because of their persistent strong association with stroke, which occurred in six patients in our study, one of whom died. All but one of these six patients had documented atrial fibrillation during follow-up. None of the six patients had residual atrial septal defects that accounted for paradoxical embolism. Two patients were receiving aspirin, whereas three were receiving warfarin. The sixth patient, who had no history of atrial flutter or fibrillation before or after surgery, was known to be in junctional rhythm during the postoperative period. Systemic hypertension was present in two of the patients. The incidence of stroke among the patients in our study, however, appears to exceed the expected annual rates for older patients with chronic atrial flutter or fibrillation, even when corrected for coexisting factors.28 Other factors, such as persistently dilated pulmonary veins,29 may contribute to thrombogenesis in older patients.
Older age and the presence of atrial flutter or fibrillation before or within one month after surgery were strong predictors of late atrial flutter or fibrillation in our study. Our data suggest that modification of the approach to adults with an atrial septal defect is needed. With the operative mortality associated with closure of atrial septal defects approaching zero, it is important to identify the subgroups of patients who can be expected to have long-term sequelae. Our data show that patients older than 40 at the time of surgery are at increased risk for cardiovascular events and, at the very least, need close surveillance. Konstantinides et al.5 reported better outcomes for patients who underwent surgery than for those who received medical treatment for an atrial septal defect after 40 years of age. These authors emphasized that atrial arrhythmias may persist despite surgery. Data from our study and from previous studies1,7 show that if we are to prevent atrial flutter and fibrillation and its associated morbidity, the closure of atrial septal defects in adults with evidence of right ventricular volume overload should not be delayed.
Recent reports have shown the safety and efficacy of the modified Cox maze procedure in restoring sinus rhythm in patients undergoing surgery to repair a defect of the mitral valve or the atrial septum.8-12,30,31 Cox et al.8 and Sandoval et al.10 proposed that the maze procedure should be considered for patients with atrial septal defects, although they acknowledged that the selection criteria remained unclear. Our study has identified patients older than 40 years of age who present with atrial flutter or fibrillation as the group at highest risk for late postoperative atrial flutter or fibrillation. The efficacy of procedures (such as the maze procedure) that are performed in addition to surgical closure of the atrial septal defect in preventing late atrial arrhythmia in high-risk patients needs to be evaluated in a randomized clinical trial.
Our study has some limitations. Volumetric data on the right atrium and right ventricle were from different sources and not always available; hence, they were not included in the analysis. The absence of a nonsurgical control group limits the ability of the study to address directly whether the closure of an atrial septal defect should be performed in all adults with a substantial left-to-right shunt. Another limitation was the relatively short follow-up period. In future studies, additional predictors of late atrial arrhythmia might be identified with a larger patient sample and a longer period of observation.
We conclude that in adults with atrial septal defects who are undergoing surgery because they have symptoms or a Qp:Qs ratio greater than 1.5:1, the presence of atrial flutter or fibrillation is related to age and pulmonary arterial pressure. To reduce the morbidity associated with late atrial flutter or fibrillation, the timely closure of atrial septal defects is warranted. For older patients, additional procedures targeting atrial arrhythmia may be required at the time of the surgical closure of the atrial septal defect.
Dr. Gatzoulis was the recipient of a Postgraduate Fellowship Award from the Department of Medicine of the University of Toronto.
We are indebted to all the cardiovascular surgeons at Toronto Hospital and to the many cardiologists and primary care physicians from the province of Ontario, Canada, who provided invaluable information for our study; to Mrs. Sue Armstrong for providing access to Toronto Hospital's cardiovascular surgical data base; to Mrs. Judith Renton for her assistance with data collection; and to all the patients who responded to our questionnaire.
Source Information
From the University of Toronto Congenital Cardiac Centre for Adults, Toronto Hospital, and the Department of Medicine, University of Toronto — both in Toronto.
Address reprint requests to Dr. Gatzoulis at the Toronto Hospital, Toronto Congenital Cardiac Centre, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada, or at gatzoul@ibm.net.
- References
References
1
Murphy JG ,Gersh BJ ,McGoon MD , et al. Long-term outcome after surgical repair of isolated atrial septal defect: follow-up at 27 to 32 years. N Engl J Med 1990;323:1645-1650
Full Text | Web of Science | Medline2
Craig RJ ,Selzer A . Natural history and prognosis of atrial septal defect. Circulation 1968;37:805-815
Web of Science | Medline3
Campbell M . Natural history of atrial septal defect. Br Heart J 1970;32:820-826
CrossRef | Web of Science | Medline4
Horvath KA ,Burke RP ,Collins JJ Jr ,Cohn LH . Surgical treatment of adult atrial septal defect: early and long-term results. J Am Coll Cardiol 1992;20:1156-1159
CrossRef | Web of Science | Medline5
Konstantinides S ,Geibel A ,Olschewski M , et al. A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med 1995;333:469-473
Full Text | Web of Science | Medline6
Mattila S ,Merikallio E ,Tala P . ASD in patients over 40 years of age. Scand J Thorac Cardiovasc Surg 1979;13:21-24
CrossRef | Medline7
St John Sutton MG ,Tajik AJ ,McGoon DC . Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up. Circulation 1981;64:402-409
CrossRef | Web of Science | Medline8
Cox JL ,Jaquiss DB ,Schuessler RB ,Boineau JP . Modification of the maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of the maze III procedure. J Thorac Cardiovasc Surg 1995;110:485-495
CrossRef | Web of Science | Medline9
Bonchek LI ,Burlingame MW ,Worley SJ ,Vazales BE ,Lundy EF . Cox/maze procedure for atrial septal defect with atrial fibrillation: management strategies. Ann Thorac Surg 1993;55:607-610
CrossRef | Web of Science | Medline10
Sandoval N ,Velasco VM ,Orjuela H , et al. Concomitant mitral valve or atrial septal defect surgery and the modified Cox-maze procedure. Am J Cardiol 1996;77:591-596
CrossRef | Web of Science | Medline11
Kamata J ,Kawazoe K ,Izumoto H , et al. Predictors of sinus rhythm restoration after Cox maze procedure concomitant with other cardiac operations. Ann Thorac Surg 1997;64:394-398
CrossRef | Web of Science | Medline12
Cox JL ,Jaquiss RDB . Atrial septal defect. N Engl J Med 1996;334:57-57
Full Text | Web of Science | Medline13
Prystowsky EN ,Benson DW Jr ,Fuster V , et al. Management of patients with atrial fibrillation: a statement for healthcare professionals from the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation 1996;93:1262-1277
Web of Science | Medline14
Cox DR . Regression models and life-tables. J R Stat Soc [B] 1972;34:187-22015
Perloff JK . Surgical closure of atrial septal defects in adults. N Engl J Med 1995;333:513-514
Full Text | Web of Science | Medline16
Satoh T ,Zipes DP . Unequal atrial stretch in dogs increases dispersion of refractoriness conducive to developing atrial fibrillation. J Cardiovasc Electrophysiol 1996;7:833-842
CrossRef | Web of Science | Medline17
Morillo CA ,Klein GJ ,Jones DL ,Guiraudon CM . Chronic rapid atrial pacing: structural, functional, and electrophysiological characteristics of a new model of sustained atrial fibrillation. Circulation 1995;91:1588-1595
Web of Science | Medline18
Liberthson RR ,Boucher CA ,Strauss HW ,Dinsmore RE ,McKusick KA ,Pohost GM . Right ventricular function in adult atrial septal defect: preoperative and postoperative assessment and clinical implications. Am J Cardiol 1981;47:56-60
CrossRef | Web of Science | Medline19
Booth DC ,Wisenbaugh T ,Smith M ,DeMaria AN . Left ventricular distensibility and passive elastic stiffness in atrial septal defect. J Am Coll Cardiol 1988;12:1231-1236
CrossRef | Web of Science | Medline20
St John Sutton MG ,Tajik AJ ,Mercier LA ,Seward JB ,Giuliani ER ,Ritman EL . Assessment of left ventricular function in secundum atrial septal defect by computer analysis of the M-mode echocardiogram. Circulation 1979;60:1082-1090
Web of Science | Medline21
Bonow RO ,Borer JS ,Rosing DR ,Bacharach SL ,Green MV ,Kent KM . Left ventricular functional reserve in adult patients with atrial septal defect: pre- and postoperative studies. Circulation 1981;63:1315-1322
CrossRef | Web of Science | Medline22
Popio KA ,Gorlin R ,Teichholz LE ,Cohn PF ,Bechtel D ,Herman MV . Abnormalities of left ventricular function and geometry in adults with an atrial septal defect: ventriculographic, hemodynamic and echocardiographic studies. Am J Cardiol 1975;36:302-308
CrossRef | Web of Science | Medline23
Nasrallah AT ,Hall RJ ,Garcia E ,Leachman RD ,Cooley DA . Surgical repair of atrial septal defect in patients over 60 years of age: long-term results. Circulation 1976;53:329-331
Web of Science | Medline24
Shah D ,Azhar M ,Oakley CM ,Cleland JGF ,Nihoyannopoulos P . Natural history of secundum atrial septal defect in adults after medical or surgical treatment: a historical prospective study. Br Heart J 1994;71:224-228
CrossRef | Web of Science | Medline25
Ward C . Secundum atrial septal defect: routine surgical treatment is not of proven benefit. Br Heart J 1994;71:219-223
CrossRef | Web of Science | Medline26
Gatzoulis MA ,Redington AN ,Somerville J ,Shore DF . Should atrial septal defects in adults be closed? Ann Thorac Surg 1996;61:657-659
CrossRef | Web of Science | Medline27
Helber U ,Baumann R ,Seboldt H ,Reinhard U ,Hoffmeister HM . Atrial septal defect in adults: cardiopulmonary exercise capacity before and 4 months and 10 years after defect closure. J Am Coll Cardiol 1997;29:1345-1350
CrossRef | Web of Science | Medline28
Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trialsArch Intern Med 1994;154:1449-1457[Erratum, Arch Intern Med 1994;154:2254.]
CrossRef | Web of Science | Medline29
Blackshear JL ,Odell JA . Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg 1996;61:755-759
CrossRef | Web of Science | Medline30
Vigano M ,Graffigna A ,Ressia L , et al. Surgery for atrial fibrillation. Eur J Cardiothorac Surg 1996;10:490-497
CrossRef | Web of Science | Medline31
Lin FY ,Huang JH ,Lin JL ,Chen WJ ,Lo HM ,Chu SH . Atrial compartment surgery for chronic atrial fibrillation associated with congenital heart defects. J Thorac Cardiovasc Surg 1996;111:231-237
CrossRef | Web of Science | Medline
- Citing Articles (98)
Citing Articles
1
Carlos A. C. Pedra, Simone R. Fontes Pedra. 2012. Atrial Level Shunts Including Partial Anomalous Pulmonary Venous Connection and Scimitar Syndrome. , 289-307.
CrossRef2
Mustafa Tarık Ağaç, Ali Rıza Akyüz, Zeydin Acar, Ramazan Akdemir, Levent Korkmaz, Abdülkadir Kırış, Emre Erkuş, Hakan Erkan, Şükrü Çelik. (2011) Evaluation of Right Ventricular Function in Early Period Following Transcatheter Closure of Atrial Septal Defect. Echocardiographyno-no
CrossRef3
Alexander Van De Bruaene, Marion Delcroix, Agnes Pasquet, Julie De Backer, Bernard Paelinck, Marielle Morissens, Werner Budts. (2011) The importance of pulmonary artery pressures on late atrial arrhythmia in transcatheter and surgically closed ASD type secundum. International Journal of Cardiology 152:2, 192-195
CrossRef4
Mikael Hanninen, Alexander Kmet, Dylan A. Taylor, David B. Ross, Ivan Rebeyka, Isabelle F. Vonder Muhll. (2011) Atrial Septal Defect Closure in the Elderly Is Associated With Excellent Quality of Life, Functional Improvement, and Ventricular Remodelling. Canadian Journal of Cardiology
CrossRef5
MARK A. CRANDALL, EMILE G. DAOUD, CURT J. DANIELS, STEVEN J. KALBFLEISCH. (2011) Percutaneous Radiofrequency Catheter Ablation for Atrial Fibrillation Prior to Atrial Septal Defect Closure. Journal of Cardiovascular Electrophysiologyno-no
CrossRef6
P. Kirchhof, G. Y. H. Lip, I. C. Van Gelder, J. Bax, E. Hylek, S. Kaab, U. Schotten, K. Wegscheider, G. Boriani, A. Brandes, M. Ezekowitz, H. Diener, L. Haegeli, H. Heidbuchel, D. Lane, L. Mont, S. Willems, P. Dorian, M. Aunes-Jansson, C. Blomstrom-Lundqvist, M. Borentain, S. Breitenstein, M. Brueckmann, N. Cater, A. Clemens, D. Dobrev, S. Dubner, N. G. Edvardsson, L. Friberg, A. Goette, M. Gulizia, R. Hatala, J. Horwood, L. Szumowski, L. Kappenberger, J. Kautzner, A. Leute, T. Lobban, R. Meyer, J. Millerhagen, J. Morgan, F. Muenzel, M. Nabauer, C. Baertels, M. Oeff, D. Paar, J. Polifka, U. Ravens, L. Rosin, W. Stegink, G. Steinbeck, P. Vardas, A. Vincent, M. Walter, G. Breithardt, A. J. Camm. (2011) Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options--a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference. Europace
CrossRef7
Masood Sadiq, Tehmina Kazmi, Asif U. Rehman, Farhan Latif, Najam Hyder, Shakeel A. Qureshi. (2011) Device closure of atrial septal defect: medium-term outcome with special reference to complications. Cardiology in the Young1-8
CrossRef8
Alexander Van De Bruaene, Philip Moons, An Belmans, Marco C. Post, Justin G. Luermans, Marion Delcroix, Agnes Pasquet, Julie De Backer, Bernard Paelinck, Marielle Morissens, Werner Budts. (2011) Predictive model for late atrial arrhythmia after closure of an atrial septal defect. International Journal of Cardiology
CrossRef9
Fang Fang, Cheuk-Man Yu, John E. Sanderson, Xiu-Xia Luo, Xin Jiang, Gabriel Wai-Kwok Yip, Yat-Yin Lam. (2011) Prevalence and Determinants of Incomplete Right Atrial Reverse Remodeling After Device Closure of Atrial Septal Defects. The American Journal of Cardiology 108:1, 114-119
CrossRef10
Luciano Daliento, Antonella Cecchetto, Francesco Bagato, Lucia Dal Bianco. (2011) A new view on congenital heart disease: clinical burden prevision of changing patients. Journal of Cardiovascular Medicine 12:7, 487-492
CrossRef11
Rohit S Loomba, Suraj Chandrasekar, Prateek Sanan, Parinda H Shah, Rohit R Arora. (2011) Association of atrial tachyarrhythmias with atrial septal defect, Ebstein’s anomaly and Fontan patients. Expert Review of Cardiovascular Therapy 9:7, 887-893
CrossRef12
Sinneary Meas, Freddy Del-Carpio Munoz, Frank Cetta, Paul Friedman. (2011) Transseptal access for pulmonary vein isolation in a patient with atrial septal closure device: Use of electrocautery and atrial septostomy. Heart Rhythm 8:6, 901-904
CrossRef13
ANDREW W. TEH, CAROLINE MEDI, GEOFFREY LEE, RAPHAEL ROSSO, PAUL B. SPARKS, JOSEPH B. MORTON, PETER M. KISTLER, KAREN HALLORAN, JITENDRA K. VOHRA, JONATHAN M. KALMAN. (2011) Long-term Outcome Following Ablation of Atrial Flutter Occurring Late after Atrial Septal Defect Repair. Pacing and Clinical Electrophysiology 34:4, 431-435
CrossRef14
M. Humenberger, R. Rosenhek, H. Gabriel, F. Rader, M. Heger, U. Klaar, T. Binder, P. Probst, G. Heinze, G. Maurer, H. Baumgartner. (2011) Benefit of atrial septal defect closure in adults: impact of age. European Heart Journal 32:5, 553-560
CrossRef15
A. Van De Bruaene, R. Buys, L. Vanhees, M. Delcroix, J.-U. Voigt, W. Budts. (2011) Regional right ventricular deformation in patients with open and closed atrial septal defect. European Journal of Echocardiography 12:3, 206-213
CrossRef16
K. Melchiorre, G. R. Sutherland, M. Liberati, A. Bhide, B. Thilaganathan. (2011) Prevalence of maternal cardiac defects in women with high-resistance uterine artery Doppler indices. Ultrasound in Obstetrics & Gynecology 37:3, 310-316
CrossRef17
Sylvia Abadir, Paul Khairy. (2011) Electrophysiology and Adult Congenital Heart Disease: Advances and Options. Progress in Cardiovascular Diseases 53:4, 281-292
CrossRef18
In-Seok Jeong, Byoung-Hee Ahn, Soon-Jin Kim, Sang-Gi Oh, Bong-Suk Oh, Sang-Hyung Kim. (2011) Mid- to Long-term Results of Surgical Treatment of ASD in Patients over 60 Years Old. The Korean Journal of Thoracic and Cardiovascular Surgery 44:2, 137
CrossRef19
Nam Kyun Kim, Su-Jin Park, Jae Young Choi. (2011) Transcatheter Closure of Atrial Septal Defect: Does Age Matter?. Korean Circulation Journal 41:11, 633
CrossRef20
, , H. Baumgartner, P. Bonhoeffer, N. M. S. De Groot, F. de Haan, J. E. Deanfield, N. Galie, M. A. Gatzoulis, C. Gohlke-Baerwolf, H. Kaemmerer, P. Kilner, F. Meijboom, B. J. M. Mulder, E. Oechslin, J. M. Oliver, A. Serraf, A. Szatmari, E. Thaulow, P. R. Vouhe, E. Walma, , A. Vahanian, A. Auricchio, J. Bax, C. Ceconi, V. Dean, G. Filippatos, C. Funck-Brentano, R. Hobbs, P. Kearney, T. McDonagh, B. A. Popescu, Z. Reiner, U. Sechtem, P. A. Sirnes, M. Tendera, P. Vardas, P. Widimsky, , T. McDonagh, L. Swan, F. Andreotti, M. Beghetti, M. Borggrefe, A. Bozio, S. Brecker, W. Budts, J. Hess, R. Hirsch, G. Jondeau, J. Kokkonen, M. Kozelj, S. Kucukoglu, M. Laan, C. Lionis, I. Metreveli, P. Moons, P. G. Pieper, V. Pilossoff, J. Popelova, S. Price, J. Roos-Hesselink, M. S. Uva, P. Tornos, P. T. Trindade, H. Ukkonen, H. Walker, G. D. Webb, J. Westby. (2010) ESC Guidelines for the management of grown-up congenital heart disease (new version 2010): The Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC). European Heart Journal 31:23, 2915-2957
CrossRef21
Tsung O. Cheng. (2010) Prevention of postoperative atrial fibrillation and/or flutter is another important reason for percutaneous instead of surgical closure of atrial septal defect in adults. International Journal of Cardiology 145:2, 215
CrossRef22
Naser M. Ammash, Sabrina D. Phillips, David O. Hodge, Heidi M. Connolly, Martha A. Grogan, Paul A. Friedman, Carole A. Warnes, Samuel J. Asirvatham. (2010) Outcome of direct current cardioversion for atrial arrhythmias in adults with congenital heart disease. International Journal of Cardiology
CrossRef23
Antonia Pijuan Domènech, Katerina Chamaidi, Michael A. Gatzoulis. 2010. Adult Congenital Heart Disease Syndromes. , 290-302.
CrossRef24
Mehmet G. Kaya, Ali Baykan, Ali Dogan, Tugrul Inanc, Ozgur Gunebakmaz, Orhan Dogdu, Kazim Uzum, Namik K. Eryol, Nazmi Narin. (2010) Intermediate-Term Effects of Transcatheter Secundum Atrial Septal Defect Closure on Cardiac Remodeling in Children and Adults. Pediatric Cardiology 31:4, 474-482
CrossRef25
Arif Anis Khan, Ju-Le Tan, W. Li, Kostas Dimopoulos, Mark S. Spence, Pak Chow, Michael J. Mullen. (2010) The Impact of Transcatheter Atrial Septal Defect Closure in the Older Population. JACC: Cardiovascular Interventions 3:3, 276-281
CrossRef26
Candice K. Silversides, Annie Dore, Nancy Poirier, Dylan Taylor, Louise Harris, Matthias Greutmann, Lee Benson, Helmut Baumgartner, David Celermajer, Judith Therrien. (2010) Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: Shunt lesions. Canadian Journal of Cardiology 26:3, e70-e79
CrossRef27
K. Dimopoulos, G.-P. Diller, R. Petraco, E. Koltsida, G. Giannakoulas, E. L. Tay, N. Best, M. F. Piepoli, D. P. Francis, P. A. Poole-Wilson, M. A. Gatzoulis. (2010) Hyponatraemia: a strong predictor of mortality in adults with congenital heart disease. European Heart Journal 31:5, 595-601
CrossRef28
2010. Synopsis of Adult Cardiac Surgical Disease. , 1-83.
CrossRef29
June Huh. (2010) Practical stepwise approach to rhythm disturbances in congenital heart diseases. Korean Journal of Pediatrics 53:6, 680
CrossRef30
Marc D. Knepp, Albert P. Rocchini, Thomas R. Lloyd, Ranjit M. Aiyagari. (2010) Long-Term Follow Up of Secundum Atrial Septal Defect Closure with the Amplatzer Septal Occluder. Congenital Heart Disease 5:1, 32-37
CrossRef31
Cha Gon Lee, Su In Jeong, June Huh, I-Seok Kang, Heung Jae Lee, Ji-Hyuk Yang, Tae Gook Jun. (2010) Surgical outcome of severe pulmonary arterial hypertension secondary to left-to-right shunt lesions. Korean Journal of Pediatrics 53:2, 195
CrossRef32
E. Mikhaylov, S. Gureev, T. Szili-Torok, D. Lebedev. (2009) Atypical atrial flutter in a patient with atrial septal defect without previous surgery: the role of septal defect as a part of the arrhythmia substrate. Europace 11:12, 1705-1708
CrossRef33
Jamil A. Aboulhosn, John S. Child. (2009) A Blue Baby Grows Up. Congenital Heart Disease 4:5, 378-383
CrossRef34
John G. T. Augoustides, E. Andrew Ochroch. (2009) Assessment of Intracardiac Shunts. International Anesthesiology Clinics 46:2, 83-103
CrossRef35
Maxime Cannesson, Michael G. Earing, Vincent Collange, Judy R. Kersten. (2009) Anesthesia for Noncardiac Surgery in Adults with Congenital Heart Disease. Anesthesiology 111:2, 432-440
CrossRef36
Jiunn-Lee Lin. (2009) Atrial fibrillation in atrial septal defects: A problem of right atrium or left atrium?. Heart Rhythm 6:7, 1007-1008
CrossRef37
Kurt C. Roberts-Thomson, Bobby John, Stephen G. Worthley, Anthony G. Brooks, Martin K. Stiles, Dennis H. Lau, Pawel Kuklik, Nicholas J. Shipp, Jonathan M. Kalman, Prashanthan Sanders. (2009) Left atrial remodeling in patients with atrial septal defects. Heart Rhythm 6:7, 1000-1006
CrossRef38
Alessandro Giardini, Andrea Donti, Francesca Sciarra, Gabriele Bronzetti, Elisabetta Mariucci, Fernando M. Picchio. (2009) Long-term incidence of atrial fibrillation and flutter after transcatheter atrial septal defect closure in adults. International Journal of Cardiology 134:1, 47-51
CrossRef39
Manabu Taniguchi, Teiji Akagi, Shinichi Ohtsuki, Yoshio Okamoto, Yasuharu Tanabe, Nobuhisa Watanabe, Koji Nakagawa, Norihisa Toh, Kengo Kusano, Shunji Sano. (2009) Transcatheter closure of atrial septal defect in elderly patients with permanent atrial fibrillation. Catheterization and Cardiovascular Interventions 73:5, 682-686
CrossRef40
U. Thilén, J. Carlson, P.G. Platonov, S.B. Olsson. (2009) Atrial myocardial pathoelectrophysiology in adults with a secundum atrial septal defect is unaffected by closure of the defect. A study using high resolution signal-averaged orthogonal P-wave technique. International Journal of Cardiology 132:3, 364-368
CrossRef41
Nicolas Majunke, Jacek Bialkowski, Neil Wilson, Malgorzata Szkutnik, Jacek Kusa, Andreas Baranowski, Corinna Heinisch, Stefan Ostermayer, Nina Wunderlich, Horst Sievert. (2009) Closure of Atrial Septal Defect With the Amplatzer Septal Occluder in Adults. The American Journal of Cardiology 103:4, 550-554
CrossRef42
Maxime Cannesson, Vincent Collange, Jean-Jacques Lehot. (2009) Anesthesia in adult patients with congenital heart disease. Current Opinion in Anaesthesiology 22:1, 88-94
CrossRef43
Christian Spies, Ziyad M. Hijazi. (2009) Transcatheter Closure of Secundum Atrial Septal Defects in the Elderly. Korean Circulation Journal 39:2, 47
CrossRef44
DHANUNJAYA LAKKIREDDY, UMAMAHESH RANGISETTY, SUBRAMANYA PRASAD, ATUL VERMA, MAZDA BIRIA, LOREN BERENBOM, RHEA PIMENTEL, MARTIN EMERT, THOMAS ROSAMOND, TAMER FAHMY, DIMPI PATEL, LUIGI DI BIASE, ROBERT SCHWEIKERT, DAVID BURKHARDT, ANDREA NATALE. (2008) Intracardiac Echo-Guided Radiofrequency Catheter Ablation of Atrial Fibrillation in Patients with Atrial Septal Defect or Patent Foramen Ovale Repair: A Feasibility, Safety, and Efficacy Study. Journal of Cardiovascular Electrophysiology 19:11, 1137-1142
CrossRef45
Christian Spies, Abha Khandelwal, Ines Timmermanns, Rainer Schräder. (2008) Incidence of Atrial Fibrillation Following Transcatheter Closure of Atrial Septal Defects in Adults. The American Journal of Cardiology 102:7, 902-906
CrossRef46
Alessandro Giamberti, Massimo Chessa, Raul Abella, Gianfranco Butera, Diana Negura, Sara Foresti, Mario Carminati, Riccardo Cappato, Alessandro Frigiola. (2008) Surgical treatment of arrhythmias in adults with congenital heart defects. International Journal of Cardiology 129:1, 37-41
CrossRef47
Konstantinos Dimopoulos, Ana Peset, Michael A. Gatzoulis. (2008) Evaluating operability in adults with congenital heart disease and the role of pretreatment with targeted pulmonary arterial hypertension therapy. International Journal of Cardiology 129:2, 163-171
CrossRef48
Nigel J. Wilson, Joanna Smith, Bundit Prommete, Clare O’Donnell, Tom L. Gentles, Peter N. Ruygrok. (2008) Transcatheter Closure of Secundum Atrial Septal Defects with the Amplatzer Septal Occluder in Adults and Children—Follow-up Closure Rates, Degree of Mitral Regurgitation and Evolution of Arrhythmias. Heart, Lung and Circulation 17:4, 318-324
CrossRef49
Taner Yavuz, Kemal Nisli, Naci Oner, Aygun Dindar, Umrah Aydogan, Rukiye Eker Omeroglu, Turkan Ertugrul. (2008) The effects of surgical repair on P-wave dispersion in children with secundum atrial septal defect. Advances in Therapy 25:8, 795-800
CrossRef50
Giuseppe Santoro, Marco Pascotto, Salvatore Caputo, Gianpiero Gaio, Carola Iacono, Ilaria Caso, Berardo Sarubbi, Marianna Carrozza, Maria Giovanna Russo, Raffaele Calabrò. (2008) Short-term electrogeometric atrial remodelling after percutaneous atrial septal defect closure. Journal of Cardiovascular Medicine 9:8, 789-793
CrossRef51
Giovanni Battista Luciani, Francesca Viscardi, Mara Pilati, Roberto Crepaz, Giuseppe Faggian, Alessandro Mazzucco. (2008) Age at Repair Affects the Very Long-Term Outcome of Sinus Venosus Defect. The Annals of Thoracic Surgery 86:1, 153-159
CrossRef52
Peter Engelfriet, Folkert Meijboom, Eric Boersma, Jan Tijssen, Barbara Mulder. (2008) Repaired and open atrial septal defects type II in adulthood: An epidemiological study of a large European cohort. International Journal of Cardiology 126:3, 379-385
CrossRef53
R. Liew, A. Catanchin, E. R. Behr, D. Ward. (2008) Use of non-contact mapping in the treatment of right atrial tachycardias in patients with and without congenital heart disease. Europace 10:8, 972-981
CrossRef54
Nestor Sandoval, Fernando Rosas, Victor Manuel Velasco. 2008. Surgical Ablation of Arrhythmias Associated with Congenital Cardiopathies. , 215-233.
CrossRef55
Nurcan Arat, Yeliz Sökmen, Hakan Altay, Fırat Özcan, Erdoğan İlkay. (2008) Left and Right Atrial Myocardial Deformation Properties in Patients with an Atrial Septal Defect. Echocardiography 25:4, 401-407
CrossRef56
Ioannis Germanakis, Sven Dittrich, Rousa Perakaki, Maria Kalmanti. (2008) Digital phonocardiography as a screening tool for heart disease in childhood. Acta Paediatrica 97:4, 470-473
CrossRef57
Candice K. Silversides, Kym Haberer, Samuel C. Siu, Gary D. Webb, Lee N. Benson, Peter R. McLaughlin, Louise Harris. (2008) Predictors of Atrial Arrhythmias After Device Closure of Secundum Type Atrial Septal Defects in Adults. The American Journal of Cardiology 101:5, 683-687
CrossRef58
Andrew W. ElBardissi, Joseph A. Dearani, Rakesh M. Suri, Gordon K. Danielson. (2008) Left-Sided Partial Anomalous Pulmonary Venous Connections. The Annals of Thoracic Surgery 85:3, 1007-1014
CrossRef59
BARBARA J. DEAL, CONSTANTINE MAVROUDIS, CARL L. BACKER. (2008) The Role of Concomitant Arrhythmia Surgery in Patients Undergoing Repair of Congenital Heart Disease. Pacing and Clinical Electrophysiology 31, S13-S16
CrossRef60
JOLIEN W. ROOS-HESSELINK, YUSUF KARAMERMER. (2008) Significance of Postoperative Arrhythmias in Congenital Heart Disease. Pacing and Clinical Electrophysiology 31, S2-S6
CrossRef61
Rajan A.G. Patel, D. Scott Lim. 2008. Congenital Heart Disease. , 178-198.
CrossRef62
Seo Jin Jea, Hyo Jin Kwon, Gi Young Jang, Jae Young Lee, Soo Jin Kim, Chang Sung Son, Joo Won Lee. (2008) Complications of transcatheter closure of atrial septal defects using the amplatzer septal occluder. Korean Journal of Pediatrics 51:4, 401
CrossRef63
Thomas K. Jones, Larry A. Latson, Evan Zahn, Craig E. Fleishman, Joth Jacobson, Robert Vincent, Kirk Kanter. (2007) Results of the U.S. Multicenter Pivotal Study of the HELEX Septal Occluder for Percutaneous Closure of Secundum Atrial Septal Defects. Journal of the American College of Cardiology 49:22, 2215-2221
CrossRef64
Takumi Yamada, Hugh T. McElderry, Masahiro Muto, Yoshimasa Murakami, G. Neal Kay. (2007) Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation After Direct Suture Closure of Congenital Atrial Septal Defect. Circulation Journal 71:12, 1989-1992
CrossRef65
Yat-Yin Lam, Cheuk-Man Yu. (2006) Improvement of biventricular function after transcatheter closure of atrial septal defect: A case report. Catheterization and Cardiovascular Interventions 68:5, 775-777
CrossRef66
Alessandro Giamberti, Massimo Chessa, Sara Foresti, Raul Abella, Gianfranco Butera, Carlo de Vincentiis, Mario Carminati, Lorenzo Menicanti, Alessandro Frigiola. (2006) Combined Atrial Septal Defect Surgical Closure and Irrigated Radiofrequency Ablation in Adult Patients. The Annals of Thoracic Surgery 82:4, 1327-1331
CrossRef67
Massimo Chessa, Paolo Arciprete, Eduardo Bossone, Luciano Daliento, Lucia Di Paola, Alessandro Distante, Saverio Sabina, Alessandro Giamberti, Sandra Giusti, Patrizia Presbitero, Berardo Sarubbi, Mario Carminati. (2006) A multicentre approach for the management of adults with congenital heart disease. Journal of Cardiovascular Medicine 7:9, 701-705
CrossRef68
A. W. Spijkerboer, E. M. W. J. Utens, W. B. Koning, A. J. J. C. Bogers, W. A. Helbing, F. C. Verhulst. (2006) Health-related Quality of Life in Children and Adolescents after Invasive Treatment for Congenital Heart Disease. Quality of Life Research 15:4, 663-673
CrossRef69
Isobel A. Russell, Kathryn Rouine-Rapp, Greg Stratmann, Wanda C. Miller-Hance. (2006) Congenital Heart Disease in the Adult: A Review with Internet-Accessible Transesophageal Echocardiographic Images. Anesthesia & Analgesia 102:3, 694-723
CrossRef70
Scott H. Buck. 2006. Arritmias en las cardiopatías congénitas. , 466-476.
CrossRef71
Paul Khairy, Annie Dore, Mario Talajic, Marc Dubuc, Nancy Poirier, Denis Roy, Lise-Andrée Mercier. (2006) Arrhythmias in adult congenital heart disease. Expert Review of Cardiovascular Therapy 4:1, 83-95
CrossRef72
Giovanni Di Salvo, Manuela Drago, Giuseppe Pacileo, Alessandra Rea, Marianna Carrozza, Giuseppe Santoro, Maurizio Cappelli Bigazzi, Pio Caso, Maria Giovanna Russo, Mario Carminati, Raffaele Calabro’. (2005) Atrial Function After Surgical and Percutaneous Closure of Atrial Septal Defect: A Strain Rate Imaging Study. Journal of the American Society of Echocardiography 18:9, 930-933
CrossRef73
ISABELLE MAGNIN-POULL, CHRISTIAN De CHILLOU, HIELKO MILJOEN, MARIUS ANDRONACHE, ETIENNE ALIOT. (2005) Mechanisms of Right Atrial Tachycardia Occurring Late After Surgical Closure of Atrial Septal Defects. Journal of Cardiovascular Electrophysiology 16:7, 681-687
CrossRef74
W. Knirsch, A. Dodge-Khatami, E. Valsangiacomo-Buechel, M. Weiss, F. Berger. (2005) Challenges Encountered During Closure of Atrial Septal Defects. Pediatric Cardiology 26:2, 147-153
CrossRef75
Omid Salehian, Eric Horlick, Markus Schwerzmann, Kim Haberer, Peter McLaughlin, Samuel C. Siu, Gary Webb, Judith Therrien. (2005) Improvements in cardiac form and function after transcatheter closure of secundum atrial septal defects. Journal of the American College of Cardiology 45:4, 499-504
CrossRef76
Thomas Hofmann, Olaf Franzen, Dietmar H. Koschyk, Yskert von Kodolitsch, Britta Goldmann, Thomas Meinertz. (2004) Three-dimensional color Doppler echocardiography for assessing shunt volume in atrial septal defects. Journal of the American Society of Echocardiography 17:11, 1173-1178
CrossRef77
Hiroyuki Nakajima, Hideki Uemura, Junjiro Kobayashi, Koji Kagisaki, Toshikatsu Yagihara, Soichiro Kitamura. (2004) Modified cavoatriotomy for combined PAPVC repair and maze procedure. The Annals of Thoracic Surgery 77:6, 2226-2227
CrossRef78
Umit Guray, Yesim Guray, Burcu Mecit, M. Birhan Yilmaz, Hatice Sasmaz, Sule Korkmaz. (2004) Maximum P Wave Duration and P Wave Dispersion in Adult Patients with Secundum Atrial Septal Defect: The Impact of Surgical Repair. Annals of Noninvasive Electrocardiology 9:2, 136-141
CrossRef79
Seden Celik, Batuhan Ozay, BahadIr Dagdeviren, Sevket Gorgulu, Aydin Yildirim, Nevzat Uslu, Bülent Ketenci, Mehmet Eren, Haldun Akgoz, Murat Demirtas, Tuna Tezel. (2004) Effect of Patient Age at Surgical Intervention on Long-Term Right Ventricular Performance in Atrial Septal Defect. Japanese Heart Journal 45:2, 265-273
CrossRef80
Brack G. Hattler, Tatiana Tsvetkova. (2003) Atrial Septal Defects in the Adult. Primary Care Case Reviews 6:4, 178-184
CrossRef81
Carina Blomström-Lundqvist, Melvin M Scheinman, Etienne M Aliot, Joseph S Alpert, Hugh Calkins, A.John Camm, W.Barton Campbell, David E Haines, Karl H Kuck, Bruce B Lerman, D.Douglas Miller, Charlie Willard Shaeffer, William G Stevenson, Gordon F Tomaselli, Elliott M Antman, Sidney C Smith, Joseph S Alpert, David P Faxon, Valentin Fuster, Raymond J Gibbons, Gabriel Gregoratos, Loren F Hiratzka, Sharon Ann Hunt, Alice K Jacobs, Richard O Russell, Silvia G Priori, Jean-Jacques Blanc, Andzrej Budaj, Enrique Fernandez Burgos, Martin Cowie, Jaap Willem Deckers, Maria Angeles Alonso Garcia, Werner W Klein, John Lekakis, Bertil Lindahl, Gianfranco Mazzotta, João Carlos Araujo Morais, Ali Oto, Otto Smiseth, Hans-Joachim Trappe. (2003) ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias —executive summary. Journal of the American College of Cardiology 42:8, 1493-1531
CrossRef82
Barbara J Deal, Constantine Mavroudis, Carl L Backer. (2003) Beyond fontan conversion: surgical therapy of arrhythmias including patients with associated complex congenital heart disease. The Annals of Thoracic Surgery 76:2, 542-554
CrossRef83
Kathryn K. Collins, Anne M. Dubin. (2003) Detecting and diagnosing arrhythmias in adults with congenital heart disease. Current Cardiology Reports 5:4, 331-335
CrossRef84
RAVI MANDAPATI, EDWARD P. WALSH, JOHN K. TRIEDMAN. (2003) Pericaval and Periannular Intra-atrial Reentrant Tachycardias in Patients with Congenital Heart Disease. Journal of Cardiovascular Electrophysiology 14:2, 119-125
CrossRef85
Zhong-Dong Du, Ziyad M Hijazi, Charles S Kleinman, Norman H Silverman, Kinley Larntz. (2002) Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults. Journal of the American College of Cardiology 39:11, 1836-1844
CrossRef86
Robert M. Steiner, Gautham P. Reddy, Stephanie Flicker. (2002) Congenital Cardiovascular Disease in the Adult Patient. Journal of Thoracic Imaging 17:1, 1-17
CrossRef87
Timothy S. Hornung, Lee N. Benson, Peter R. McLaughlin. (2002) Catheter interventions in adult patients with congenital heart disease. Current Cardiology Reports 4:1, 54-62
CrossRef88
M. TANAKA, C.I. BERUL, M. ISHII, P.Y. JAY, H. WAKIMOTO, P. DOUGLAS, N. YAMASAKI, T. KAWAMOTO, J. GEHRMANN, C.T. MAGUIRE, M. SCHINKE, C.E. SEIDMAN, J.G. SEIDMAN, Y. KURACHI, S. IZUMO. (2002) A Mouse Model of Congenital Heart Disease: Cardiac Arrhythmias and Atrial Septal Defect Caused by Haploinsufficiency of the Cardiac Transcription Factor Csx/Nkx2.5. Cold Spring Harbor Symposia on Quantitative Biology 67:1, 317-326
CrossRef89
Fause Attie, Martín Rosas, Nuria Granados, Carlos Zabal, Alfonso Buendía, Juan Calderón. (2001) Surgical treatment for secundum atrial septal defects in patients >40 years old. Journal of the American College of Cardiology 38:7, 2035-2042
CrossRef90
Henry W Kort, David T Balzer, Mark C Johnson. (2001) Resolution of right heart enlargement after closure of secundum atrial septal defect with transcatheter technique. Journal of the American College of Cardiology 38:5, 1528-1532
CrossRef91
Gruschen R Veldtman, Vanessa Razack, Samuel Siu, Hassan El-Hajj, Fiona Walker, Gary D Webb, Leland N Benson, Peter R McLaughlin. (2001) Right ventricular form and function after percutaneous atrial septal defect device closure. Journal of the American College of Cardiology 37:8, 2108-2113
CrossRef92
MICHAEL J. LANDZBERG. (2001) Closure of Atrial Septal Defects in Adult Patients: Justification of the "Tipping Point". Journal of Interventional Cardiology 14:2, 267-270
CrossRef93
Sarah S. LeRoy. (2001) Clinical Dysrhythmias After Surgical Repair of Congenital Heart Disease. AACN Clinical Issues: Advanced Practice in Acute & Critical Care 12:1, 87-99
CrossRef94
Ian H Law, Peter S Fischbach, Caren Goldberg, Ralph S Mosca, Edward L Bove, Thomas R Lloyd, Albert P Rocchini, Macdonald Dick. (2001) Inducibility of intra-atrial reentrant tachycardia after the first two stages of the Fontan sequence. Journal of the American College of Cardiology 37:1, 231-237
CrossRef95
Felix Berger, Michael Vogel. (2000) Reply. The Annals of Thoracic Surgery 69:3, 981
CrossRef96
Brickner, M. Elizabeth, Hillis, L. David, Lange, Richard A., . (2000) Congenital Heart Disease in Adults. New England Journal of Medicine 342:4, 256-263
Full Text97
Kevin M. Shannon. (1999) Arrhythmias in congenital heart disease. Current Treatment Options in Cardiovascular Medicine 1:4, 373-379
CrossRef98
(1999) Atrial Arrhythmia in Atrial Septal Defect. New England Journal of Medicine 341:7, 540-541
Full Text
- Letters
