4-015 Age-based Differences in cardiac dysrhythmias and major adverse cardiac and cerebrovascular events among adults undergoing open access atrial septal defect repair and the need for permanent pacemaker implantation

Background Adults with atrial septal defect(ASD) are vulnerable to complications, including embolic stroke, cardiac dysrhythmias, and myocardial injury. Contemporary data on open-access ASD repair among adults is lacking. We aim to investigate the odds of several cardiac arrhythmias and major adverse cardiac and cerebrovascular events (MACCE) among adults undergoing open-access ASD repair based on age groups.Methods We evaluated patients with ASD who were hospitalized with a primary procedural code for open-access atrial septal repair using the 2016–2021 National Inpatient Sample(NIS). Our study excluded cases younger than 18 and those with a co-existing pacemaker prior to admission. The sample was stratified for ages 18–44 years and ≥45. Multivariable regression analysis helped understand the age-based differences in the incidence of paroxysmal atrial fibrillation, ventricular tachycardia, ventricular fibrillation, supraventricular tachycardia, and atrial flutter, among others. We also explored the odds of undergoing permanent pacemaker(PPM) implantation during their hospitalization. Finally, the odds of MACCE between them were compared.Results Our selection yielded 3515 procedures of open-access ASD repair, with 73.4% involving adults ages≥45 years while 26.6% were between 18 and 44 years. Events of paroxysmal atrial fibrillation (aOR 2.486, 95% CI 1.662–3.717, p<0.01), supraventricular tachycardia (aOR 2.513, 95% CI 1.521–4.153, p<0.01) and atrial flutter(aOR 2.890, 95% CI 1.663–5.023, p<0.01) were more common in the older group. No differences were observed for ventricular tachycardia(aOR 1.333, 95% CI 0.699–2.541, p=0.383) or ventricular fibrillation (aOR 1.081, 95% CI 0.620–1.883, p=0.785). In addition, both groups had comparable odds of needing PPM during their hospitalization(aOR 0.830, 95% CI 0.411–1.675, p=0.603). Our older group of patients was also more likely to report MACCE(aOR 1.364, 95% CI 1.019–1.826, p=0.037).Conclusion Adults 45 and older were prone to paroxysmal atrial fibrillation, supraventricular tachycardia, and atrial flutter during their hospitalization for open-access ASD repair. Such cardiac events potentially contributed to higher odds of MACCE. Our findings highlight the critical need for intensive pre-, peri-, and post-operative electrophysiology monitoring and long-term follow-up.