Atrial septal defect medical therapy

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Atrial Septal Defect Microchapters


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Ostium Secundum Atrial Septal Defect
Ostium Primum Atrial Septal Defect
Sinus Venosus Atrial Septal Defect
Coronary Sinus
Patent Foramen Ovale
Common or Single Atrium


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Medical Therapy


Indications for Surgical Repair
Surgical Closure
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Robotic ASD Repair
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3] Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]


Definitive treatment of atrial septal defect involves surgical closure of the defect. Medical therapy has a limited role in the management of ASD, 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 drug usage in patients with atrial septal defects. Medical therapy in patients with atrial septal defect is administered in certain conditions like arrhythmias [1].

  • In asymptomatic patients with small shunts and normal right ventricle size, 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.

ASD and Stroke

Aspirin has been found to decrease the incidence of recurrent stroke and transient ischemic attacks in patients with atrial septal defect and patent foramen ovale [2]. The American Heart Association guidelines support the utilization of sustained warfarin therapy in high-risk atrial septal defect patients.[3]

ASD and Migraine

Effective pharmacologic therapies for migraine prevention include:

2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)[6]

Recommendations for Medical Therapy (DO NOT EDIT)[6]

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)"


  1. Prystowsky EN, Benson DW, Fuster V, Hart RG, Kay GN, Myerburg RJ; et al. (1996). "Management of patients with atrial fibrillation. A Statement for Healthcare Professionals. From the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association". Circulation. 93 (6): 1262–77. PMID 8653857.
  2. 2.0 2.1 Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G; et al. (2001). "Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both". N Engl J Med. 345 (24): 1740–6. doi:10.1056/NEJMoa011503. PMID 11742048.
  3. Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P, American College of Chest Physicians (2008). "Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 630S–669S. doi:10.1378/chest.08-0720. PMID 18574275.
  4. Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP, PFO in Cryptogenic Stroke Study (PICSS) Investigators (2002). "Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study". Circulation. 105 (22): 2625–31. PMID 12045168.
  5. Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC; et al. (2011). "Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association". Stroke. 42 (1): 227–76. doi:10.1161/STR.0b013e3181f7d043. PMID 20966421.
  6. 6.0 6.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

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