Factors determining occurrence of arrhythmias in patients post-closure of atrial septal defects

Abstract

Objectives This study aimed to determine the risk factors for the occurrence of arrhythmias after either transcatheter or surgical closure of atrial septal defect. Methods This prospective study included 150 patients admitted for transcatheter or surgical closure of atrial septal defect. Transthoracic echocardiography together with a twelve-leads ECG were done during 1 and 3 months follow up. The paired T, chi-square and Logistic regression tests were used to detect any association between any arrhythmias and factors that may affect its occurrence. Results One-hundred and twenty-three patients had percutaneous device closure while the remaining 27 patients had surgical closure. The youngest and oldest of the studied patients being 3 & 50 years old respectively with female (108) over male (42) predominance in incidence. After closure, 8 patients at one month and another 3 patients at three months follow up out of the total 150 patients had supraventricular arrhythmias in the form of frequent premature atrial contractions (6 patients), atrioventricular nodal re-entrant tachycardia (2 patients), and paroxysmal Atrial fibrillation (3 patients). No conduction abnormalities nor ventricular arrhythmias occurred. Multivariate analysis showed that age, P wave dispersion, systolic myocardial velocity of right ventricle, and systolic pulmonary artery pressure were independently associated with the occurrence of atrial arrhythmia after atrial septal defect repair. Conclusion Age, P wave dispersion, Systolic pulmonary artery pressure, and systolic myocardial velocity of the right ventricle are independent risk factors to develop arrythmias in patients after atrial septal defect closure.

Atrial Septal Defect & Patent Foramen Ovale: Features of Ultrasound Diagnostics, Treatment and Monitoring in Children at the Present Stage

“…Постперикардиотомный синдром развивается в первые несколько дней/недель после операции, сопровождаясь лихорадкой, болью в грудной клетке и животе, рвотой, слабостью, одышкой, что отмечается на ЭхоКГ появлением жидкости в полости перикарда и плевральной полости с риском развития тампонады сердца. Интересно отметить, что долгосрочное наблюдение (более 40 лет) среди пациентов, которым была проведена операция с искусственным кровообращением, демонстрирует редкое развитие осложнений (обычно это наджелудочковые аритмии, легочная гипертензия), риск их оказался выше у пациентов, возраст которых на момент операции был старше 25 лет [28].…”

Arrhythmic Risk and Treatment after Transcatheter Atrial Septal Defect Closure

“…A study conducted by Clark which included 15 patients with secundum ASD showed that 5 patients presented sinus node dysfunction or atrioventricular node dysfunction before repair [ 14 ]. On the other hand, atrioventricular block post-transcatheter closure of ASD occurs in rare instances, and it can be transient or may progress to complete heart block [ 15 ]. When compared with patients with unclosed ASD, Albaek et al showed that those with interventional ASD closure were at higher risk of developing atrioventricular block, incomplete right bundle branch block, or left anterior fascicular block and had a higher demand for pacemaker implantation [ 16 ].…”

“…Mansour et al demonstrated that age, P wave dispersion, the systolic myocardial velocity of the right ventricle (S’), and systolic pulmonary artery pressure are independent risk factors for atrial arrhythmias in multivariate analysis [ 15 ]. Moreover, Van de Bruaene et al proposed a risk score, in which male gender, atrial arrhythmia before repair, atrial arrhythmia ≤ 1 month, and systolic pulmonary artery pressure ≥ 25 mmHg are predisposing factors in the development of late atrial arrhythmias [ 23 ].…”

“…Age ≥ 40 yrs [20][21][22] Male gender [23] Metabolic syndrome [24] Thyroid dysfunction [24] Atrial arrhythmia before closure [23,24] Atrial arrhythmia ≤ 1 month after closure [23] BNP levels ≥ 40 pg/mL [19] Echocardiography parameters Larger ASD defect [24,25] Multiple ASDs [24] LA and RA dysfunction/remodeling [9,26,27] Mitral valve disease [24] SPAP ≥ 25 mmHg [15,23] Impaired systolic myocardial velocity of RV [15] Electrocardiography parameters Increased P-wave duration/dispersion [9,15,28,29] Crochetage sign [30] QT interval, QTc duration and dispersion [29,31] Tp-e interval, Tp-e/QT ratio [31] Parameters related to the procedure or the device Larger device size [17,24] Fenestrated occluder [24] ASO/ASL ratio > 0.576 [32] Longer fluoroscopy time [17] ASD-atrial septal defect; BNP-brain natriuretic peptide; LA-left atrium; RA-right atrium; SPAP-systolic pulmonary arterial pressure; RV-right ventricle; Tp-e-T wave to peak-end interval;; QTc -corrected QT interval; ASO-atrial septal occluder; ASL-atrial septal length.…”