Percutaneous closure of ostium secundum atrial septal defect (ASD) has become the standard of care for this condition. However the occurrence of supraventricular arrhythmias remain insufficiently studied. We conducted this study to identify predictors of long-term supraventricular arrhythmias following percutaneous ASD closure.

We performed a retrospective single-center study including patients who underwent percutaneous ostium secundum ASD closure at Marie Lannelongue Hospital between 1998 and 2021. Procedural and long-term follow-up data were systematically collected. Patients with a prior history of supraventricular arrhythmia were excluded from the main analysis. A comparative analysis was then performed between patients who developed new-onset supraventricular arrhythmia during long-term follow-up and those who did not.

Among the 1,495 patients without pre-procedural atrial arrhythmia, 98 (6.5%) developed atrial arrhythmia during long-term follow-up (median follow-up: 10.0 years). In univariate analysis, patients who developed post-procedural arrhythmias were significantly older (48.5 vs. 18.0 years, p < 0.001), more frequently had a body mass index ≥ 30 kg/m ² ( p = 0.003), and had higher CHA ₂ DS ₂ -VASc scores ( p < 0.001). On baseline electrocardiography, complete right bundle branch block ( p = 0.04) and atrial premature beats ( p = 0.009) were more frequent. Echocardiographic features associated with arrhythmia included interatrial septal aneurysm ( p = 0.008) and left ventricular dysfunction ( p = 0.01). Hemodynamic data showed significantly higher pulmonary artery pressures ( p < 0.001), and larger device size was also associated with arrhythmia occurrence ( p < 0.001). During long-term follow-up, patients who developed atrial arrhythmias experienced significantly higher rates of stroke, heart failure, pacemaker implantation, and all-cause mortality (all p < 0.001). Multivariate analysis is currently ongoing, and a predictive risk score for long-term supraventricular arrhythmia after ASD closure is under development.

New-onset atrial arrhythmia represents a clinically significant source of morbidity after percutaneous ASD closure. Identification of predictive factors and development of a dedicated risk score may allow more targeted long-term rhythm monitoring in these patients.