The impact of iatrogenic atrial septal defect on the prognosis of left atrial appenda ge closure in patients with nonvalvular atrial fibrillation

Atrial fibrillation (AF) is a common arrhythmia in clinical practice, and stroke is a serious complication. Left atrial appendage closure (LAAC) is an effective method for preventing thromboembolism in AF patients. During LAAC, transient or permanent atrial septal defect may occur, known as iatrogenic atrial septal defect (iASD).We selected NVAF patients who were hospitalized and had LAAC. Based on the results of transthoracic echocardiography examination(TTE) three days after surgery, the study population was divided into the iASD group and the non-iASD group. We collected patient basic information, interventional surgery-related information, and postoperative follow-up results. We calculated the incidence of postoperative iASD. We used statistical methods to explore the influencing factors of iASD and the differences in prognosis between the two groups of patients. P  < 0.05 is considered statistically significant.A total of 899 patients were enrolled in this study, including 510 males and 389 females, with an average age of 69.0 ± 8.9 years. Three days after LAAC, a total of 640 cases of iASD were detected in the iASD group, with an incidence rate of 71.2%. Through multiple factor binary logistic regression, it was found that female gender [Odds ratio (OR): 1.512], lower body mass index (BMI) (OR: 0.921), larger mean occluder diameter (OR: 1.113), and smaller mean occluder compression rate (OR: 0.966) were independent risk factors for iASD in NVAF patients undergoing LAAC ( P  < 0.05). Within one year of postoperative follow-up, there was no statistically significant difference between the two groups in terms of device-related thrombosis (DRT), pericardial tamponade, stroke, major bleeding, hospitalization for heart failure, and cardiac death.Female gender, lower BMI, larger average occluder diameter, and smaller average occluder compression rate are independent risk factors for postoperative iASD in NVAF patients undergoing LAAC. There was no statistically significant difference between the iASD group and the non-iASD group in terms of DRT, pericardial tamponade, stroke, major bleeding, hospitalization for heart failure, and cardiac death.