HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Berger, F. Articles by Vogel, M. Search for Related Content PubMed Articles by Berger, F. Articles by Vogel, M. Related Collections Related Article

Ann Thorac Surg 2000;69:981
© 2000 The Society of Thoracic Surgeons

---

Correspondence

Reply

^a Department Congenital Heart Disease, Deutsches Herzzentrum, Postfach 650505, D-13305 Berlin, Germany
^b GUCH Unit, Middlesex Hospital, Mortimer St, Jules Thorn Building 5th Floor, London, England W1N 8AA, UK,

e-mail: vogelmdr{at}hotmail.com

To the Editor

We thank Dr Cheng for his comments on our paper. In our opinion, there are three important reasons to close atrial septal defects in all adults: (a) prevention of atrial flutter or fibrillation [1], (b) prevention of the development of pulmonary vascular disease [2], and (c) improvement of quality of life. In our patient group, we also found patients who developed transient flutter or fibrillation after surgery. These patients were all older than 40 years and the tachycardia occurred 3 [2 to 5] days after surgery, when these patients were still on intravenous heparin and thus effectively anticoagulated. Thus, we fortunately did not encounter patients with a stroke in the immediate postoperative period. Among the 18 patients who developed atrial flutter/fibrillation de novo, 6 could be converted to sinus rhythm with intravenous verapamil, and 12 with cardioversion. The latter patient group was treated with sotalol for at least 1 year to prevent recurrence of flutter. We did not continue anticoagulation in those patients with transient flutter, who responded to electrical or pharmacological conversion to sinus rhythm, but monitor these patients closely to detect recurrence of atrial flutter/fibrillation. While we anticoagulate all patients with persistent or intermittent atrial flutter/fibrillation [3], we are not sure whether routine anticoagulation of all patients over the age of 35 years who had undergone closure of an atrial septal defect is warranted.

References

1. Gatzoulis M.A., Freeman M.A., Siu S.C., Webb G.D., Harris L. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 1999;340:839-846.[Abstract/Free Full Text]
2. Vogel M., Berger F., Kramer A., Alexi-Meskisvili V., Lange P.E. Incidence of secondary pulmonary hypertension in adults with atrial septal or sinus venosus defect. Heart 1999;82:30-33.[Abstract/Free Full Text]
3. Berger F., Vogel M., Kramer A., Alexi-Meskishvili V., Weng Y., Lange P.E., Hetzer R. Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg 1999;68:75-78.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Berger, F. Articles by Vogel, M. Search for Related Content PubMed Articles by Berger, F. Articles by Vogel, M. Related Collections Related Article