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Introduction As per the European Society of Cardiology (ESC) guidelines for the management of adult congenital heart disease (2020), patients who have undergone repair of an atrial septal defect (ASD) at a young age (<25) without any residual shunt, elevated pulmonary arterial pressure (PAP), or right ventricular dilatation, do not require regular ACHD follow-up. Conversely, those repaired at adult age (particularly >40) or with residual shunting post-repair, elevated PAP, or arrhythmias before/after repair should be reviewed regularly. We sought to analyse adherence to these recommendations and identify the excess follow-up burden using a patient sample derived from a Level 1 ACHD centre.Methods We reviewed the clinic letters of consecutive patients attending ACHD clinic at the East Midlands Congenital Heart Centre between 01/01/2023 and 31/12/2023. Filtering by the listed diagnoses on the clinic letters, we synthesised a registry of patients with a diagnosis of ASD. Isolating a sample set from patients carrying an ASD diagnosis. we collected data on demographics, ASD subtype and closure status, details of closure procedures, haemodynamic and structural information derived from cardiac imaging, and arrhythmias. We then used the ESC guidance to evaluate whether the respective appointment and follow-up plan determined in clinic were appropriate.Results In the period between 01/01/2023 and 31/12/2023, there were 88 individual ACHD clinics comprising 1430 individual appointment slots. There were 113 DNAs and 1317 attended appointments, attended by 1307 individual patients. Of the 1430 total appointment slots, 223 slots were for patients with a diagnosis of ASD. Of this subgroup, there were 19 DNAs and 204 attended appointments, attended by 204 individual patients.We analysed a sample of 68 appointments (one third of the total attended) for patients with ASD. 49 patients from this sample had undergone repair/closure. There were 9 patients with no valid indication for review, as specified by ESC guidelines, and of these, 6 patients were planned for further follow-up while 3 patients were discharged. 10 patients qualified for follow-up solely due to being of adult age at repair, and of these, 7 were planned for further follow-up, while 3 patients were discharged. 3 patients qualified for follow-up due to mild right ventricular dilation (+/- adult age at repair) and were all duly seen and planned for further clinic follow-up.Conclusions In an analysis of patients with an Atrial Septal Defect seen in the East Midlands Congenital Heart Centre, we estimated that 13% were reviewed despite having no ESC-specified requirement for monitoring. Further, another 19% of patients who were of adult age at repair and/or demonstrated mild right ventricular dilation, may be contributing an unnecessary follow-up burden.