Atrial septal aneurysm and cardiac arrhythmias

Association between atrial septal aneurysm and arrhythmias

Objective. This study aimed to assess the association of atrial septal aneurysm (ASA) with cardiac arrhythmias by comparing patients with ASA with a control group with non-ASA, matched for age and gender. Methods. 641 patients with ASA who fulfilled the inclusion criteria were enrolled into the study. The control group consisted of 641 patients without ASA. Patients underwent physical, electrocardiographic and transthoracic echocardiographic examinations. Additional examinations such as transesophageal echocardiography, 24-h rhythm Holter monitoring, and electrophysiological study were performed when clinically needed. Results. There were no differences between the groups in respect to baseline demographic, clinical parameters and echocardiographic parameters except ischemic stroke and smoking status. Percentages of patients suffering from atrial premature complex (APC), ventricular premature complex (VPC), supraventricular tachycardia (SVT) and paroxysmal atrial fibrillation (AF) were higher in ASA patients compared to non-ASA patients. In addition, these parameters were independently associated with the presence of ASA in logistic regression analysis. Conclusions. Certain types of arrhythmias such as APC, VPC, SVT and paroxysmal AF have been shown to be independently associated with the presence of ASA.

Interatrial septum: A pictorial review of congenital and acquired pathologies and their management

There are many different congenital abnormalities and acquired pathologies involving the interatrial septum. Differentiation of these pathologies significantly affects patient management. We have reviewed the various interatrial septal pathologies and discussed their congenital associates, clinical significance, and management. After reading this article, the reader should be able to better characterize the interatrial septal pathologies using the optimal imaging tools, and have a better understanding of their clinical significance and management.

Atrial septal aneurysm: Prevalence and covariates in adults

BACKGROUND

Atrial septal aneurysm is a localized deformity of interatrial septum, generally at the level of fossa ovalis which protrudes into right or left atrium or both. The purpose of this study was to assess the frequency and covariates of atrial septal aneurysm in adult patients undergoing transthoracic echocardiography in our outpatient clinic.

MATERIALS AND METHODS

From December 2011 to May 2016, 16,570 patients were included in the study. Records of patients were retrospectively analyzed from our previously established database. All cardiovascular examinations and echocardiographical examinations had been done during this period. Briefly, protrusion of interatrial septum more than 15mm into the right or left atrium with an at least 15mm diameter base of interatrial septum confirmed the diagnosis of atrial septal aneurysm.

RESULTS

Atrial septal aneurysm has been documented in 393 patients (2.4%) in our study population. Mild to moderate mitral and aortic valve regurgitation have been demonstrated in 153 (39%) patients and in 61(16%) patients respectively. Sixty one (16%) of patients had the diagnosis of supraventricular arrhythmia of whom 52% underwent radiofrequency ablation procedure.

CONCLUSION

In conclusion we have documented that valvular regurgitation and supraventricular arrhythmias are common concurrent pathologies with atrial septal aneurysm.

Atrial Septal Aneurysms and Supraventricular Arrhythmias: The Role of Atrial Electromechanical Delay

BACKGROUND

Paroxysmal supraventricular arrhythmias (SVAs) frequently occur in patients with atrial septal aneurysm (ASA). The aim of the current study was to evaluate the electrocardiographic (P-wave duration and dispersion) and echocardiographic (atrial electromechanical delay, AEMD) noninvasive indicators of atrial conduction heterogeneity in healthy ASA subjects without interatrial shunt and to assess the AEMD role in predicting the SVAs onset in this population.

MATERIALS AND METHODS

One hundered ASA patients (41 males, mean age of 32.5 ± 8 years) and 100 healthy subjects used as controls, matched for age and gender, were studied for the occurrence of SVAs during a 4-year follow-up, through 30-day external loop recorder (ELR) monitoring performed every 3 months. ASAs were diagnosed by transthoracic echocardiography based on the criteria of a minimal aneurismal base of ≥15 mm and an excursion of ≥10 mm. Intra-AEMD and inter-AEMD of both atria were measured through tissue Doppler echocardiography. P-wave dispersion (PD) was carefully measured using 12-lead electrocardiogram (ECG).

RESULTS

Compared to the healthy control group, the ASA group showed a statistically significant increase in inter-AEMD, intra-left AEMD, maximum P-wave duration, and PD. Dividing the ASA group into 2 subgroups (patients with or without SVAs), the inter-AEMD, intra-left AEMD, P max, and PD were significantly higher in the subgroup with SVAs compared to the subgroup without SVAs. There were significant good correlations of intra-left AEMD and inter-AEMD with PD. A cutoff value of 40.1 msec for intra-left AEMD had a sensitivity of 82% and a specificity of 83% in identifying ASA patients at risk for SVA.

CONCLUSION

Our results showed that the echocardiographic AEMD indices (intra-left and inter-AEMD) and the PD were significantly increased in healthy ASA subjects without interatrial shunt. PD and AEMD represent noninvasive, inexpensive, useful, and simple parameters to assess the SVAs' risk in ASA patients.

Atrial septal aneurysms in childhood: prevalence, classification, and concurrent abnormalities

OBJECTIVES

This study sought to investigate the prevalence of atrial septal aneurysms in the paediatric population and to define coexisting abnormalities and their incidence.

BACKGROUND

Few papers refer to the prevalence of atrial septal aneurysms in childhood.

METHODS

We enrolled a total of 4522 children aged more than 12 months who underwent a transthoracic echocardiography. Atrial septal aneurysm was defined as a protrusion of the interatrial septum or part of it >15 mm beyond the plane of the atrial septum or phasic excursion of the interatrial septum during the cardiorespiratory cycle of at least 15 mm in total amplitude and a diameter of the base of the aneurysm of at least 15 mm.

RESULTS

Atrial septal aneurysms were found in 47 children (1.04%). They involved almost the entire septum in 14 patients (28.89%) and were limited to the fossa ovalis in 33 (71.11%). An atrial septal aneurysm was an isolated structural defect in 17 (35.56%). In 30 (64.44%) patients, it was associated with interatrial shunting - atrial septal defect and patent foramen ovale. At the echo follow-up after a year, no changes were recorded.

CONCLUSIONS

Prevalence of atrial septal aneurysms is almost 1%. The most common abnormalities associated are interatrial shunts, that is, a patent foramen ovale and an atrial septal defect. From a medical point of view, it is suggested that no action is to be taken during childhood, as a child with an atrial septal aneurysm is not at increased risk compared with a child without one. Follow-up is scheduled on an individual basis.

Is there a relationship between atrial septal aneurysm and atrial tachycardia?

We describe the case of a 37-year-old woman with atrial tachycardia associated to atrial septal aneurysm. We consider a localized reentry mechanism as the pathogenetic mechanism of the arrhythmia as demostrated by means of electrophisiological evaluation and electroanatomical mapping. The treatment by radiofrequency appears as an effective and well tolerated treatment of this unusual left atrial tachycardia.

Huge interatrial septal aneurysm: a coincidental but rather fatal finding

We report the case of a patient with a huge interatrial septal aneurysm as an intraoperative coincidental finding that led to a fatal outcome. The patient was admitted to our hospital in order to undergo elective coronary artery bypass grafting because he suffered from severe coronary artery disease. We intraoperatively diagnosed by transesophageal echocardiography a huge interatrial septal aneurysm mimicking a right atrial tumor. The aneurysm was initially resected and then coronary artery bypass grafting was successfully performed but the patient never achieved a successful separation from cardiopulmonary bypass probably because of massive embolic events.

Evaluation of the relationship between atrial septal aneurysm and cardiac arrhythmias via P-wave dispersion and signal-averaged P-wave duration

OBJECTIVE

The aim of the study was to investigate the relationship between atrial septal aneurysms (ASAs) and cardiac arrhythmias via signal-averaged P-wave duration (SAPWD) and P-wave dispersion (Pd).

METHODS

Sixty-six patients with ASA served as the study group (group 1; 28 men and 38 women; mean age, 34 +/- 10 years) and 62 healthy volunteers served as the control group (group 2; 29 men and 33 women; mean age, 31 +/- 8 years) in the current study. ASAs were diagnosed by transthoracic echocardiography based on the criteria of a minimal aneurysmal base of > or =15 mm; and an excursion of > or =10 mm. All subjects were evaluated by 24-hour Holter monitoring, 12 lead body surface electrocardiogram for P-wave analysis, and signal-averaged electrocardiogram for P-wave duration (PWD).

RESULTS

There was no significant difference between the study and control groups in terms of age, gender, left atrium diameter, and left ventricular ejection fraction. Supraventricular arrhythmias (SVAs) were detected in 29 patients with ASA (43.9%) and 5 controls (8.1%; P < 0.001). The mean Pd in patients with ASA was significantly longer compared to the control group (14.1 +/- 8 ms vs 7.0 +/- 2.9 ms; P < 0.001). Similarly, the mean SAPWD in group 1 was significantly longer compared to group 2 (127.4 +/- 17.6 ms vs 99.8 +/- 12.3 ms; P < 0.001).

CONCLUSION

Prolonged SAPWD and Pd were determined to indicate electrical disturbances in the atrial myocardium, and predict the increase in the prevalence of SVA in patients with ASA.

Relationship between atrial septal aneurysms and atrial electromechanical delay

Atrial septal aneurysm (ASA) is a saccular deformity located in the atrial septum. Atrial arrhythmias are common in patients with ASA. Atrial electromechanical delay (AEMD) can be used to evaluate development of atrial arrhythmias in various settings. The aim of the study was to investigate the relationship between ASA, cardiac arrhythmias and AEMD. Seventy patients with ASA served as the study group (30 men; mean age, 33.6 ± 10.9 years) and 70 healthy volunteers served as the control group (34 men; mean age, 31.4 ± 7.8 years). ASAs were diagnosed by transthoracic echocardiography based on the criteria of a minimal aneurysmal base of ≥ 15 mm; and an excursion of ≥ 10 mm. Inter-AEMD and intra-AEMDs of both atrium were measured from parameters of tissue Doppler imaging. There was no significant difference between the study and control groups in terms of age, gender, left atrium diameter, and left ventricular ejection fraction. Inter-AEMD (50.7 ± 22.5 ms vs. 36.9 ± 12.0 ms) and intra-left AEMD (44.6 ± 17.4 ms vs. 30.7 ± 11.6 ms) were significantly higher in patients with ASA with respect to control group. Inter-AEMD (63.6 ± 20.1 ms vs. 45.1 ± 21.5 ms, P = 0.001), intra-left AEMD (55.3 ± 15.6 ms vs. 40.1 ± 16.2 ms, P = 0.001), diameter of the ASA (19.9 ± 3.6 mm vs. 17.1 ± 2.7 mm, P = 0.001) and P wave dispersion (18.5 ± 6.7 ms vs. 11.8 ± 7.3 ms, P = 0.001) were significantly greater in the subgroup with arrhythmias compared to the subgroup without arrhythmias. Inter-AEMD and intra-left AEMD were found to be significantly prolonged in patients with ASA. Being a non-invasive, inexpensive and simple technique AEMD may provide significant contributions to assess the risk for paroxysmal supraventricular arrhythmia in patients with ASA.

The prospective follow-up of the natural course of interatrial communications diagnosed in 847 newborns

AIMS

The aim of this study was to evaluate the prevalance of interatrial communications (IACs) and IAC types in a large series of newborns, to establish the incidence of spontaneous closure of IACs, to determine the relationship between spontaneous closure and the size and type of IACs, and to investigate the incidence of mitral valve prolapse (MVP) and atrial arrhythmia in newborn infants with atrial septal aneurysm (ASA).

METHODS AND RESULTS

Between 2000 and 2001, a total of 1100 asymptomatic and term newborns were evaluated. Those who had congenital heart diseases and failed to attend the follow-up visits were excluded from the study. The remaining 847 newborns were followed until the closure time or in those where closure did not occur, for a maximum time of 45 months (mean 25 +/- 3 months, range 1-45 months). The mean age at diagnosis was 1.7 +/- 1.4 days (range 1-7 days). According to echocardiographic evaluation, cases were classified into four groups based on the initial size of IAC and into three groups based on the type of IAC. At the end of the 45th month IACs were closed spontaneously in 98.6% of the cases. There was significant relationship between the diameter of IAC and the timing of the closure (P < 0.01). The closure time in the cases with ASA was significantly longer than the cases with valve-like opening and multiple fenestration (P < 0.01). In female newborns, the defects remained open for a significantly longer period than male newborns (P = 0.0397). There was no significant relationship between ASA and atrial arrhythmias (P = 0.294). None of the newborns had MVP.

CONCLUSION

The cases with IACs < 3 mm do not need follow-up. However, the cases with IACs > 3 mm do need to be followed until the defect closes completely. Those with ASA should be followed-up regularly, because these defects can remain open. Spontaneous closure occurs significantly earlier in cases with valve-like opening and multiple fenestration.

ECHOCARDIOGRAPHIC AND DOPPLER DIAGNOSIS: FIRST CASE OF ATRIAL SEPTAL ANEURYSM IN A CAT

A 6-year-old female cat developed pleural and abdominal effusion. Cardiac ultrasound and 2D color tissue Doppler imaging revealed restrictive cardiomyopathy with severe biatrial dilatation and hypertension. This cardiomyopathy was associated with atrial septal aneurysm and a patent foramen ovale. The atrial septal aneurysm involved the entire atrial septum. Necropsy and histological examination confirmed all these findings. ASA is a rare malformation and, as in this cat, it generally occurs concomitantly with congenital or acquired heart disease and may be explained by greater pressure in one atrium, leading to controlateral protrusion of the atrial septum.