Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery

Background. There is controversy about the benefit of surgical repair for a trial septal defect in adults, especially its effect on the incidence of su praventricular dysrhythmias, atrial nutter and fibrillation. We studied the ir incidence before and after operation. Methods. We examined surface and 24-hour Holter electrocardiograms before, early (between 3 and 7 days), and late (more than 6 months) after operation , performed at age 42.2 years (range, 18.5 to 74.9 years), in 211 adults wi th atrial septal defect. Patients were arbitrarily divided into three group s: age 18 to 40 years (n = 101), age 40 to 60 years (n = 83), and age more than 60 years (n = 27). All consecutive patients operated on between Januar y 1988 and December 1996 and having a pulmonary to systemic now ratio of 1. 5:1 or greater were included in this study. Results, The age of patients without arrhythmias before or after atrial sep tal defect closure (39 +/- 13 years) was significantly lower than that of p atients with flutter (54 +/- 12 years) or fibrillation (59 +/- 8 years). Th e incidence of atrial flutter was influenced by surgical repair as atrial f lutter converted to sinus rhythm late after operation in 10 of 18 patients. However, there was no change in the incidence of atrial fibrillation befor e (n = 28) and after (n = 21) operation. Conclusions. Our data show that surgical correction of atrial septal defect leads to regression of the incidence of atrial flutter but not fibrillatio n. Thus, surgical repair of atrial septal defect to abolish supraventricula r tachyarrhythmias in adults is warranted, but in patients with fibrillatio n, it may have to be combined with a Maze operation in the future. (C) 1999 by The Society of Thoracic Surgeons.