Atrial septal defect medical therapy


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Definitive treatment of atrial septal defect involves surgical closure of the defect. Medical therapy has limited role in management and is often used to manage complications like arrhythmia, congestive heart failure and other comorbidities associated with atrial septal defects such as stroke and migraine.

Medical therapy
There are no widely used guidelines for medical therapy usage in patients with atrial septal defects. Medical therapy in patients of atrial septal defect is administered in certain conditions like arrhythmias. Also, medical therapy can be used to manage conditions associated with atrial septal defects.


 * In asymptomatic patients with small shunts and normal right ventricle size generally no medical therapy is required. Routine follow-up assessment of symptoms like arrhythmia, paradoxical embolic events should be done. Also, a repeat echocardiogram should be obtained every 2 to 3 years.


 * Treatment of atrial arrhythmia and restoration of sinus rhythm is recommended. In cases with atrial fibrillation, antiarrhythmic and anticoagulation therapy is recommended.

==ACC/AHA recommendations for medical therapy in patients with atrial septal defects (DONOT EDIT)==

Class I

1) Cardioversion after appropriate anticoagulation is recommended to attempt restoration of the sinus rhythm if atrial fibrillation occurs. (Level of Evidence: A)

2) Rate control and anticoagulation are recommended if sinus rhythm cannot be maintained by medical or interventional means.(Level of Evidence: A)