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Deaconu S, Deaconu A, Marascu G, Stanculescu MO, Cozma D, Cinteza E, Vatasescu R. Arrhythmic Risk and Treatment after Transcatheter Atrial Septal Defect Closure. Diagnostics (Basel) 2023; 14:33. [PMID: 38201344 PMCID: PMC10795847 DOI: 10.3390/diagnostics14010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Atrial septal defect (ASD) represents the most common congenital heart defect identified in adulthood. Atrial and ventricular geometric remodeling due to intracardiac shunt increase the risk of arrhythmias, especially atrial fibrillation (AF). Clinical, echocardiography, electrocardiogram, and device-related predictors may be used to assess the risk of atrial arrhythmias after ASD closure. The underlying mechanisms in these patients are complex and at least in part independent of the structural remodeling secondary to hemodynamic overload. Device closure of the ASD itself and its timing impact future arrhythmia risk, as well as posing a challenge for when transseptal puncture is required. Sudden cardiac death (SCD) risk is higher than in the general population and an implantable cardioverter-defibrillator (ICD) may be indicated in selected cases.
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Affiliation(s)
| | - Alexandru Deaconu
- Cardiology Department, Clinic Emergency Hospital, 014461 Bucharest, Romania; (G.M.); (M.O.S.); (R.V.)
- Cardio-Thoracic Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Gabriela Marascu
- Cardiology Department, Clinic Emergency Hospital, 014461 Bucharest, Romania; (G.M.); (M.O.S.); (R.V.)
| | | | - Dragoș Cozma
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania;
| | - Eliza Cinteza
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Radu Vatasescu
- Cardiology Department, Clinic Emergency Hospital, 014461 Bucharest, Romania; (G.M.); (M.O.S.); (R.V.)
- Cardio-Thoracic Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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2
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Atrial arrhythmias in patients beyond 40 Years of age post atrial septal defect device closure. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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3
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Himelfarb JD, Shulman H, Olesovsky CJ, Rumman RK, Oliva L, Friedland J, Farrell A, Huszti E, Horlick E, Abrahamyan L. Atrial fibrillation following transcatheter atrial septal defect closure: a systematic review and meta-analysis. Heart 2021; 108:1216-1224. [PMID: 34675040 DOI: 10.1136/heartjnl-2021-319794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset atrial fibrillation and flutter (AFi/AFl). These arrhythmias confer an increased risk of postoperative stroke, thrombus formation and systemic emboli. This systematic review examines the burden of de novo AFi/AFl in adults following transcatheter closure and seeks to identify risk factors for AFi/AFl development. METHODS Studies were identified by a search of MEDLINE, EMBASE and Cochrane databases from inception until 29 April 2020. A meta-analysis of AFi/AFl incidence was performed using a random-effects model. RESULTS A total of 31 studies met inclusion criteria, comprising 4788 adult patients without a history of AFi/AFl. Twenty-three studies were included in quantitative synthesis and demonstrated an overall incidence rate of 1.82 patients per 100 person-years of follow-up (I2=83%). In studies that enrolled only patients ≥60 years old, the incidence was 5.21 patients per 100 person-years (I2=0%). Studies with follow-up duration ≤2 years reported an incidence of 4.05 per 100 person-years (I2=55%) compared with a rate of 1.19 per 100 person-years (I2=85%) for studies with follow-up duration >2 years. CONCLUSIONS The incidence of new-onset AFi/AFl is relatively low following transcatheter closure of secundum ASDs. The rate of de novo AFi/AFl, however, was significantly higher in elderly patients. Shorter follow-up time was associated with a higher reported incidence of AFi/AFl.
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Affiliation(s)
| | - Healey Shulman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Rawan K Rumman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura Oliva
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Joshua Friedland
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Farrell
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Ella Huszti
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Biostatistics Research Unit, University Health Network, Toronto, Ontario
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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4
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Celik M, Yilmaz Y, Kup A, Karagoz A, Kahyaoglu M, Cakmak EO, Celik FB, Sengor BG, Guner A, Izci S, Kilicgedik A, Candan O, Kahveci G, Gecmen C, Kaymaz C. Crochetage sign may predict late atrial arrhythmias in patients with secundum atrial septal defect undergoing transcatheter closure. J Electrocardiol 2021; 67:158-165. [PMID: 34246066 DOI: 10.1016/j.jelectrocard.2021.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Atrial arrhythmias are well-known complications of atrial septal defect (ASD), and associated with substantial morbidity. After ASD closure, right atrial and ventricular enlargement regresses, however, the risk of atrial arrhythmia development continues. In this study, we aimed to investigate the relationship between the Crochetage sign, which is a possible reflection of heterogeneous ventricular depolarization due to long-term hemodynamic overload, and the development of late atrial arrhythmia after ASD closure. METHODS This retrospective study included a total of 314 patients (mean age: 39.5 (30-50) years; male: 115) who underwent percutaneous device closure for secundum ASD. The study population was divided into two groups according to the presence or absence of the Crochetage sign. The Crochetage sign was defined as an M-shaped or bifid pattern notch on the R wave in one or more inferior limb leads. Cox-regression analysis was performed to determine independent predictors of late atrial arrhythmia development. RESULT Fifty-seven patients (18.1%) presented with late atrial arrhythmia. Of these 57 patients, 30 developed new-onset atrial fibrillation/atrial flutter (AF/AFL), and 27 patients with pre-procedure paroxysmal AF/AFL had a recurrence of AF/AFL during follow-up. History of paroxysmal AF/AFL before the procedure (HR: 4.78; 95% CI 2,52-9.05; p < 0.001), the presence of Crochetage sign (HR: 3.90; 95% CI 2.05-7.76; p < 0.001), and older age at the time of ASD closure (HR: 1.03; 95% CI 1.01-1.06; p = 0.002) were found as independent predictors for late atrial arrhythmia. CONCLUSION The presence of Crochetage sign may be used to predict the risk of late atrial arrhythmia development after transcatheter ASD closure.
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Affiliation(s)
- Mehmet Celik
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
| | - Yusuf Yilmaz
- Department of Cardiology, Istanbul Medeniyet Universty, Istanbul, Turkey
| | - Ayhan Kup
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ali Karagoz
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Muzaffer Kahyaoglu
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ender Ozgun Cakmak
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Fatma Betul Celik
- Department of Cardiology, Istanbul Medeniyet Universty, Istanbul, Turkey
| | - Busra Guvendi Sengor
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ahmet Guner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training & Research Hospital, Istanbul, Turkey
| | - Servet Izci
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Alev Kilicgedik
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ozkan Candan
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Gokhan Kahveci
- Department of Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Cetin Gecmen
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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5
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O'Neill L, Floyd CN, Sim I, Whitaker J, Mukherjee R, O'Hare D, Gatzoulis M, Frigiola A, O'Neill MD, Williams SE. Percutaneous secundum atrial septal defect closure for the treatment of atrial arrhythmia in the adult: A meta-analysis. Int J Cardiol 2020; 321:104-112. [PMID: 32679141 DOI: 10.1016/j.ijcard.2020.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/24/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Atrial arrhythmias are common in patients with atrial septal defects (ASD) but the effects of percutaneous closure on atrial arrhythmia prevalence is unclear. We investigated the effects of ASD device closure and the impact of age at time of closure on prevalent atrial arrythmia. METHODS Meta-analysis of studies reporting atrial arrhythmia prevalence in adult patients before and after percutaneous closure was performed. Primary outcomes were prevalence of 'all atrial arrhythmia' and atrial fibrillation alone post closure. Sub-group analysis examined the effects of closure according to age in patients; <40 years, ≥40 and ≥ 60 years. 25 studies were included. RESULTS Meta-analysis of all studies demonstrated no reduction in all atrial arrhythmia or atrial fibrillation prevalence post-closure (OR 0.855, 95% CI 0.672 to 1.087, P = .201 and OR 0.818, 95% CI 0.645 to 1.038, P = .099, respectively). A weak reduction in all atrial arrhythmia and atrial fibrillation was seen in patients ≥40 years (OR 0.77, 95% CI 0.616 to 0.979, P = .032 and OR 0.760, 95% CI 0.6 to 0.964, P = .024, respectively) but not ≥60 years (OR 0.822, 95% CI 0.593 to 1.141, P = .242 and OR 0.83, 95% CI 0.598 to 1.152, P = .266, respectively). No data were available in patients <40 years. This, and other limitations, prevents conclusive assessment of the effect of age on arrhythmia prevalence. CONCLUSIONS Overall, percutaneous ASD closure is not associated with a reduction in atrial arrhythmia prevalence in this meta-analysis. A weak benefit is seen in patients ≥40 years of age, not present in patients ≥60 years.
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Affiliation(s)
| | - Christopher N Floyd
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Iain Sim
- King's College London, London, United Kingdom
| | | | | | | | - Michael Gatzoulis
- Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | - Steven E Williams
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Vyas V, Kaura A, Sawhney V, Lowe M, Ezzat V. Atrial tachyarrhythmias following percutaneous device closure of secundum atrial septal defects. IJC HEART & VASCULATURE 2020; 27:100490. [PMID: 32181321 PMCID: PMC7063168 DOI: 10.1016/j.ijcha.2020.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/25/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
Background Atrial tachyarrhythmias (ATs) are a major source of morbidity in the atrial septal defect (ASD) patient cohort. The optimal timing and approach of anti-arrhythmic intervention is currently unclear. Here, we sought to determine the overall rate of ATs following percutaneous ASD closure and risk factors that may predict this. Methods A systematic search of the literature was performed using the search terms '(Secundum Atrial Septal Defects AND Atrial arrhythmias) AND (transcatheter closure or percutaneous closure or device closure)'. All studies in English reporting the rate of ATs following percutaneous closure of secundum ASDs in adult patients were included. The primary outcome was documented AT detection during follow-up ECG monitoring. A meta-regression was then performed to test for an interaction between demographic/procedural characteristics and the primary outcome. Results 13 observational studies including 2366 patients were analysed. The overall post-procedure AT event detection rate was 8.6%. Multivariate meta-regression analysis revealed that only male gender was associated with a higher rate of post-procedure AT detection while utilisation of the Amplatzer Septal Occluder device was associated with a lower AT detection rate and comprised 96.2% of all devices used. A high level of heterogeneity was observed (I2-statistic 92.3%, Q value 156.8). Conclusions Our study illustrates that despite percutaneous ASD closure, a high proportion of adult patients have ATs with male gender correlating with higher AT rates. While the Amplatzer Septal Occluder device correlated with lower AT rates, this was the overwhelmingly the predominant device used hence comparison to other devices remains challenging.
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Affiliation(s)
- Vishal Vyas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Amit Kaura
- Department of Cardiology, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Vinit Sawhney
- Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Martin Lowe
- Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Vivienne Ezzat
- Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
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7
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Ioseliani DG, Kovalchuk IA, Rafaeli TR, Rogatova AN, Stepanov AV, Zakharova OV, Pekarskaya MV. Simultaneous Percutaneous Coronary Intervention and Endovascular Closure of Atrial Septal Defect in Adults. KARDIOLOGIYA 2019; 59:56-60. [PMID: 30853022 DOI: 10.18087/cardio.2019.2.10222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/18/2022]
Abstract
AIM to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect. MATERIALS AND METHODS Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6 %) the procedure of endovascular repair of secondary ASD was combined with performed at same session oronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9. RESULTS At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100 %. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm3, right ventricular volume - from 45.2±5.1 to 33.4±3.8 cm3, systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiography good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W. CONCLUSION Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.
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Affiliation(s)
- D G Ioseliani
- Sechenov First Moscow State Medical University (Sechenov University)..
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8
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Long-term outcome of catheter ablation for atrial tachyarrhythmias in patients with atrial septal defect. J Interv Card Electrophysiol 2019; 54:217-224. [PMID: 30603853 DOI: 10.1007/s10840-018-0505-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to evaluate efficacy, safety, and long-term outcome of radiofrequency catheter ablation (RFCA) for atrial tachyarrhythmia (ATa) in patients with atrial septal defect (ASD). METHODS Seventy-five ASD patients with ATa (52% atrial fibrillation, AF) were enrolled. Electrophysiological study and RFCA were performed, with endpoints of index and multiple procedures as follows: (a) atrial tachycardia/atrial flutter (AT/AFL), absence of inducibility of any atrial arrhythmia and (b) AF, circumferential pulmonary vein ablation (CPVA, paroxysmal AF), bidirectional block of lines, and disappearance of complex fractionated atrial electrograms (persistent and long-standing persistent (LSP)-AF). RESULTS Cumulative success rate at 1-year follow-up was 79.9% and dropped to 59.0% at a median follow-up of 63 months (range, 14-114 months) for multiple procedures (mean 1.6 ± 0.7 [1-3]). Freedom from ATa after multiple procedures was achieved in 75% patients with AT/AFL and 43.6% patients with AF (P = 0.006 for comparison). In multivariate analysis, older age at ASD correction (HR, 1.033 [95% CI, 1.008-1.059]; P = 0.01), ASD diameter before correction (HR, 1.054 [95% CI, 1.006-1.105]; P = 0.027), and first-diagnosed ATa type (AF; HR, 2.25 [95% CI, 1.03-4.92]; P = 0.042) were significant independent predictors of ATa recurrence. Patients with more risk factors had higher risk of ATa recurrence. CONCLUSIONS The long-term outcome of RFCA for ATa outcome was favorable for AT/AFL while mediocre for AF. ATa recurrence was more common in patients with older age at ASD correction, larger ASD diameter before correction, and first-diagnosed AF. Patients with more risk factors had higher ATa recurrence risk.
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10
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Alnasser S, Lee D, Austin PC, Labos C, Osten M, Lightfoot DT, Kutty S, Shah A, Meier L, Benson L, Horlick E. Long term outcomes among adults post transcatheter atrial septal defect closure: Systematic review and meta-analysis. Int J Cardiol 2018; 270:126-132. [DOI: 10.1016/j.ijcard.2018.06.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/22/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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11
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Bredy C, Mongeon FP, Leduc L, Dore A, Khairy P. Pregnancy in adults with repaired/unrepaired atrial septal defect. J Thorac Dis 2018; 10:S2945-S2952. [PMID: 30305955 DOI: 10.21037/jtd.2017.10.130] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Atrial septal defect (ASD) is the most common form of congenital heart disease. Left-to-right shunting leads to right ventricular (RV) volume overload with excessive pulmonary blood flow. Complications include exercise intolerance, pulmonary vascular disease, RV dysfunction, paradoxical thromboemboli, and atrial arrhythmias. Women with coexisting severe pulmonary hypertension should be counselled against pregnancy due to high incidence of maternal and fetal morbidity and mortality. In the absence of pulmonary hypertension, pregnancy is generally well tolerated in the setting of an ASD. Nevertheless, hemodynamic changes throughout gestation may increase the risk for complications, particularly in those with unrepaired ASDs. Arrhythmias are the most common cardiac event and occur in 4-5%, followed by paradoxical emboli in 2-5%. Obstetrical and neonatal complications include preeclampsia, a higher incidence of infants born small for gestational age, and higher fetal/perinatal mortality. Although there is no definitive evidence demonstrating superiority of an aggressive approach to ASD closure prior to pregnancy, it is currently common practice to electively close asymptomatic but large and/or hemodynamically significant ASDs prior to childbearing. Cardiology follow up during pregnancy should be adapted to clinical circumstances and includes transthoracic echocardiography during the second trimester and arrhythmia monitoring in the event of symptoms.
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Affiliation(s)
- Charlène Bredy
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - François-Pierre Mongeon
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - Line Leduc
- Department of Obstetrics, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - Annie Dore
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - Paul Khairy
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
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12
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Ávila P, Oliver JM, Gallego P, González-García A, Rodríguez-Puras MJ, Cambronero E, Ruiz-Cantador J, Campos A, Peinado R, Prieto R, Sarnago F, Yotti R, Fernández-Avilés F. Natural History and Clinical Predictors of Atrial Tachycardia in Adults With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005396. [DOI: 10.1161/circep.117.005396] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Pablo Ávila
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - José María Oliver
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Pastora Gallego
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Ana González-García
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - María José Rodríguez-Puras
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Esther Cambronero
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - José Ruiz-Cantador
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Ana Campos
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Rafael Peinado
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Raquel Prieto
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Fernando Sarnago
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Raquel Yotti
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Francisco Fernández-Avilés
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
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Schneeberger Y, Schaefer A, Conradi L, Brickwedel J, Reichenspurner H, Kozlik-Feldmann R, Detter C. Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care. Interact Cardiovasc Thorac Surg 2017; 24:603-608. [PMID: 28040751 DOI: 10.1093/icvts/ivw366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/10/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives Percutaneous ostium secundum atrial septal defect (ASD II) closure has become the standard of care for treatment of congenital ASD II in adults. Nevertheless, patients are frequently ineligible for this technique due to challenging morphology. In such cases, closure via minimally invasive cardiac surgery (MICS) is an appropriate treatment option. The aim of this study is to compare outcomes of MICS and use of a percutaneous Amplatzer septal occluder (ASO) device for treatment of ASD II in adults. Methods From July 2002 to June 2014, 95 patients underwent MICS for congenital ASD II closure. During the same period, 169 patients underwent ASO procedure. Outcomes in terms of remaining ASD II, new onset atrial fibrillation (AF), post-interventional stroke, myocardial infarction and the post procedural implementation of anticoagulation were compared. Results Apart from age (38.3 ± 12.7 vs 49.6 ± 15.7 years, P < 0.0001) the groups did not differ in baseline characteristics. A significantly higher rate of residual ASD II was found in the ASO group at 3 months (0% vs 30.8%, P < 0.0001), 6 months (0% vs 15.9%, P < 0.0001) and 12 months follow-up (0% vs 7.1%, P = 0.005). A significantly higher rate of new-onset AF was seen in the ASO group (0% vs 9.5%, P = 0.0008). Conclusions MICS for ASD II is a safe and reproducible procedure with 0% mortality in our cohort. More complete closure of ASD, decreased rates of new onset AF and decreased need for oral anticoagulation are the advantages of the MICS procedure. Compared with the current standard of care, the MICS approach is feasible regardless of ASD morphology.
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Affiliation(s)
- Yvonne Schneeberger
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Jens Brickwedel
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | | | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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14
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Atrial flutter/fibrillation in patients receiving transcatheter closure of atrial septal defect. J Formos Med Assoc 2016; 116:522-528. [PMID: 27816405 DOI: 10.1016/j.jfma.2016.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/PURPOSE Atrial flutter/fibrillation (AFL/Af) is a common late complication in atrial septal defect (ASD) patients even after occluder implantation. We try to delineate the risk factors of persistent AFL/Af. METHODS From 1998 to 2010, all patients older than 18 years of age who received ASD occluder implantation in our hospital were enrolled, and their records were retrospectively reviewed. In addition, renin-angiotensin system gene polymorphisms including angiotensinogen gene, A1166C polymorphism on the angiotensin II type I receptor gene, and insertion/deletion (I/D) patterns on the angiotensin-converting enzyme gene were checked using direct sequencing. RESULTS A total of 517 patients (male/female 127/390) were enrolled. The mean age of patients receiving occluder deployment was 41.5 ± 14.5 years. Prior to occluder deployment, 3.9% of patients had persistent Af, 3.1% of patients had paroxysmal Af, and 0.8% had AFL. After a follow-up of 1894 patient-years, 3.5% had persistent Af and 1.9% of patients had paroxysmal Af. The greatest risk factors of AFL/Af genesis included age, occluder size, presence of multiple ASDs, and underlying thyroid or mitral valve disorder (p < 0.001, p < 0.001, p = 0.033, p = 0.016, and p = 0.012, respectively). Preoperative AFL/Af status is the most important factor in determining AFL/Af resolution and progression after an intervention. The renin-angiotensin system gene polymorphisms had no association with AFL/Af genesis, and progression or resolution after intervention. CONCLUSION AFL/Af is common after ASD occluder implantation, and predisposed by older age, larger and multiple ASDs, and underlying disorders. Preoperative atrial arrhythmia status is the most important predictor of AFL/Af progression or resolution. Renin-angiotensin system gene polymorphisms had no association with AFL/Af.
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15
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Duong P, Ferguson LP, Lord S, Murray S, Shepherd E, Bourke JP, Crossland D, O'Sullivan J. Atrial arrhythmia after transcatheter closure of secundum atrial septal defects in patients ≥40 years of age. Europace 2016; 19:1322-1326. [DOI: 10.1093/europace/euw186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/29/2016] [Indexed: 01/08/2023] Open
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16
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Brouwer C, Hazekamp MG, Zeppenfeld K. Anatomical Substrates and Ablation of Reentrant Atrial and Ventricular Tachycardias in Repaired Congenital Heart Disease. Arrhythm Electrophysiol Rev 2016; 5:150-60. [PMID: 27617095 DOI: 10.15420/aer.2016.19.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Advances in surgical repair techniques for various types of congenital heart disease have improved survival into adulthood over the past decades, thus exposing these patients to a high risk of atrial and ventricular arrhythmias later in life. These arrhythmias arise from complex arrhythmogenic substrates. Substrate formation may depend on both pathological myocardial remodelling and variable anatomical boundaries, determined by the type and timing of prior corrective surgery. Accordingly, arrhythmogenic substrates after repair have changed as a result of evolving surgical techniques. Radiofrequency catheter ablation offers an important therapeutic option but remains challenging due to the variable anatomy, surgically created obstacles and the complex arrhythmogenic substrates. Recent technical developments including electroanatomical mapping and image integration for delineating the anatomy facilitate complex catheter ablation procedures. The purpose of this review is to provide an update on the changing anatomical arrhythmogenic substrates and their potential impact on catheter ablation in patients with repaired congenital heart disease and tachyarrhythmias.
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Affiliation(s)
- Charlotte Brouwer
- Department of Cardiology, Leiden University Medical Centre, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, The Netherlands
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17
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Mid-to-long-term follow-up results of transcatheter closure of atrial septal defect in patients older than 40 years. Heart Vessels 2016; 32:467-473. [DOI: 10.1007/s00380-016-0886-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
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18
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Park KM, Hwang JK, Chun KJ, Park SJ, On YK, Kim JS, Park SW, Kang IS, Song J, Huh J. Prediction of early-onset atrial tachyarrhythmia after successful trans-catheter device closure of atrial septal defect. Medicine (Baltimore) 2016; 95:e4706. [PMID: 27583905 PMCID: PMC5008589 DOI: 10.1097/md.0000000000004706] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Atrial tachyarrhythmia is a well-known long-term complication of atrial septal defect (ASD) in adults, even after successful trans-catheter closure. However, the risk factors for early-onset atrial tachyarrhythmia after trans-catheter closure remain unclear. This retrospective study enrolled adults with secundum ASD undergoing trans-catheter closure from January 2000 to March 2014. We analyzed the clinical characteristics of patients and assessed risk factors for new-onset atrial tachyarrhythmia defined as a composite of atrial fibrillation or flutter (AF/AFL) after ASD closure. We enrolled a total of 427 patients; 123 were male (28.8%) and the median age was 37.0 (interquartile range [IQR]: 18.3-49.0). Nineteen (4.4%) patients had documented atrial tachyarrhythmia during the follow-up period (median: 11.4 months [IQR: 5.4-24]). Patients with transient AF/AFL during closure showed a greater incidence of new-onset atrial tachyarrhythmia during the follow-up period than patients with consistent sinus rhythm during closure (27.3% vs 3.8%; P = 0.01). Most new-onset atrial tachyarrhythmias were documented within 6 months (median: 2.6 [IQR: 1.2-4.1] months) of closure. In the multivariate analysis, the risk for new-onset atrial tachyarrhythmia was significant in patients with AF/AFL during closure (hazard ratio [HR]: 9.90, 95% confidence interval [CI]: 2.86-34.20; P < 0.001), deficient posteroinferior rim (HR: 5.48, 95% CI: 1.15-25.72; P = 0.04), and age of closure over 48 years (HR: 3.30, 95% CI: 1.30-8.38; P = 0.01). In conclusion, transient AF/AFL during trans-catheter closure of ASD as well as deficient posteroinferior rim and age of closure over 48 years may be useful for predicting early new-onset atrial tachyarrhythmia after device closure.
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Affiliation(s)
| | | | | | | | | | | | | | - I-Seok Kang
- Grown-Up Congenital Heart Disease Clinic, Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Grown-Up Congenital Heart Disease Clinic, Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Grown-Up Congenital Heart Disease Clinic, Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence: June Huh, Grown-Up Congenital Heart Disease Clinic, Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea (e-mail: ; ; )
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ROY KARINE, GOMEZ-PULIDO FEDERICO, ERNST SABINE. Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S45-56. [DOI: 10.1111/jce.12903] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- KARINE ROY
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - FEDERICO GOMEZ-PULIDO
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - SABINE ERNST
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
- Biomedical Research Unit, National Heart and Lung Institute; Imperial College London; London UK
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20
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Chen L, Bai Y, Wang FY, Zhang ZG, Shan XH, Chen T, Zhao XX, Qin YW. Transcatheter closure of atrial septal defects improves cardiac remodeling and function of adult patients with permanent atrial fibrillation. Chin Med J (Engl) 2015; 128:780-3. [PMID: 25758272 PMCID: PMC4833982 DOI: 10.4103/0366-6999.152617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Permanent atrial fibrillation (AF) is the most common form of dysrhythmia associated with atrial septal defects (ASDs) in patients older than 40 years. However, little is known about cardiac remodeling after transcatheter closure in patients with permanent AF. This study was designed to compare cardiac events and remodeling effects after transcatheter closure in such patients. Methods: Clinical data of 289 adult patients older than 40 years who underwent ASD closure at our center were analyzed retrospectively. Of them, 63 patients with permanent AF were assigned to the case group, and the other 226 patients without permanent AF were assigned to the control group. Cardiac events and changes in left and right cardiac cavity dimensions before the procedure and 6 months after the procedure were compared between the two groups. Results: Patients in the case group were significantly older than those in the control group. The right ventricular (RV) volume and right atrial (RA) volume were decreased significantly in both the groups during a median follow-up period of 6 months after closure (P < 0.001). The left atrial dimensions, left ventricular end-systolic dimensions, left ventricular end-diastolic dimensions and left ventricular ejection fraction showed no significant change before and after the procedure in both the groups. Changes of the RV volume and RA volume in the case group were significantly smaller than those in the control group (P = 0.005 and P < 0.001). The New York Heart Association cardiac function was improved in both the groups during the 6 months follow-up period. Conclusions: The transcatheter closure of ASD can improve the cardiac remodeling and cardiac function in patients with or without AF.
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Affiliation(s)
| | | | | | | | | | | | | | - Yong-Wen Qin
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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21
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Abstract
Secundum atrial septal defect (ASDII) is a common congenital heart defect that causes shunting of blood between the systemic and pulmonary circulations. Patients with an isolated ASDII often remain asymptomatic during childhood and adolescence. If the defect remains untreated, however, the rates of exercise intolerance, supraventricular arrhythmias, right ventricular dysfunction and pulmonary arterial hypertension (PAH) increase with patient age, and life expectancy is reduced. Transcatheter and surgical techniques both provide valid options for ASDII closure, the former being the preferred method. With the exception of those with severe and irreversible PAH, closure is beneficial to, and thus indicated in all patients with significant shunts, regardless of age and symptoms. The symptomatic and survival benefits conferred by defect closure are inversely related to patient age and the presence of PAH, supporting timely closure after diagnosis. In this paper we review the management of adult patients with an isolated ASDII, with a focus on aspects of importance to the decision regarding defect closure and medical follow-up.
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Nyboe C, Olsen MS, Nielsen-Kudsk JE, Hjortdal VE. Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure. Heart 2015; 101:706-11. [DOI: 10.1136/heartjnl-2014-306552] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/27/2015] [Indexed: 11/03/2022] Open
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Catheter ablation of atrial fibrillation in patients with atrial septal defect: long-term follow-up results. J Interv Card Electrophysiol 2014; 42:43-9. [DOI: 10.1007/s10840-014-9958-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/14/2014] [Indexed: 11/25/2022]
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Chubb H, Whitaker J, Williams SE, Head CE, Chung NA, Wright MJ, O'Neill M. Pathophysiology and Management of Arrhythmias Associated with Atrial Septal Defect and Patent Foramen Ovale. Arrhythm Electrophysiol Rev 2014; 3:168-72. [PMID: 26835086 DOI: 10.15420/aer.2014.3.3.168] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/11/2014] [Indexed: 11/04/2022] Open
Abstract
Atrial septal defects (ASDs) are among the most common of congenital heart defects and are frequently associated with atrial arrhythmias. Atrial and ventricular geometrical remodelling secondary to the intracardiac shunt promotes evolution of the electrical substrate, predisposing the patient to atrial fibrillation and other arrhythmias. Closure of an ASD reduces the immediate and long-term prevalence of atrial arrhythmias, but the evidence suggests that patients remain at an increased long-term risk in comparison with the normal population. The closure technique itself and its timing impacts future arrhythmia risk profile while subsequent transseptal access following surgical or device closure is complicated. Newer techniques combined with increased experience will help to alleviate some of the difficulties associated with optimal management of arrhythmias in these patients.
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Affiliation(s)
- Henry Chubb
- Division of Imaging Sciences and Biomedical Engineering, King's College London; Department of Paediatric Cardiology, Evelina London Children's Hospital
| | - John Whitaker
- Division of Imaging Sciences and Biomedical Engineering, King's College London
| | - Steven E Williams
- Division of Imaging Sciences and Biomedical Engineering, King's College London; Adult Congenital Heart Disease Group, Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, UK
| | - Catherine E Head
- Adult Congenital Heart Disease Group, Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, UK
| | - Natali Ay Chung
- Adult Congenital Heart Disease Group, Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, UK
| | - Matthew J Wright
- Division of Imaging Sciences and Biomedical Engineering, King's College London
| | - Mark O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London; Adult Congenital Heart Disease Group, Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, UK
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Chubb H, Williams SE, Wright M, Rosenthal E, O'Neill M. Tachyarrhythmias and catheter ablation in adult congenital heart disease. Expert Rev Cardiovasc Ther 2014; 12:751-70. [PMID: 24783943 DOI: 10.1586/14779072.2014.914434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advances in surgical technique have had an immense impact on longevity and quality of life in patients with congenital heart disease. However, an inevitable consequence of these surgical successes is the creation of a unique patient population whose anatomy, surgical history and haemodynamics result in the development of a challenging and complex arrhythmia substrate. Furthermore, this patient group remains susceptible to the arrhythmias seen in the general adult population. It is through a thorough appreciation of the cardiac structural defect, the surgical corrective approach, and haemodynamic impact that the most effective arrhythmia care can be delivered. Catheter ablation techniques offer a highly effective management option but require a meticulous attention to the real-time integration of anatomical and electrophysiological information to identify and eliminate the culprit arrhythmia substrate. This review describes the current approach to the interventional management of patients with tachyarrhythmias in the context of congenital heart disease.
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Affiliation(s)
- Henry Chubb
- Division of Imaging Sciences and Biomedical Engineering and Division of Cardiovascular Medicine, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
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Smith B, Thomson J, Crossland D, Spence MS, Morgan GJ. UK multicenter experience using the gore septal occluder (GSOTM) for atrial septal defect closure in children and adults. Catheter Cardiovasc Interv 2013; 83:581-6. [DOI: 10.1002/ccd.25216] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/05/2013] [Accepted: 09/14/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Ben Smith
- Yorkhill Hospital; Glasgow United Kingdom
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De Bruaene AV, Moons P, Belmans A, Post MC, Luermans JG, Delcroix M, Pasquet A, De Backer J, Paelinck B, Morissens M, Budts W. Predictive model for late atrial arrhythmia after closure of an atrial septal defect. Int J Cardiol 2013; 164:318-22. [DOI: 10.1016/j.ijcard.2011.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 07/03/2011] [Indexed: 11/16/2022]
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29
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Woo SB, Jang SI, Kim SH, Kim SJ, Lee SY, Baek JS, Shim WS. Transcatheter closure of secundum atrial septal defect in patients over 60 years old. Korean Circ J 2013; 43:110-4. [PMID: 23508193 PMCID: PMC3596657 DOI: 10.4070/kcj.2013.43.2.110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/30/2012] [Accepted: 11/01/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Atrial septal defect (ASD) is the one of most common congenital heart diseases detected in adults. Along with remarkable development of device technology, the first treatment strategy of secundum ASD has been transcatheter closure in feasible cases. However, there are only a few publications regarding the results of transcatheter closure of ASD in elderly patients, especially those over 60 years of age. We report our results of transcatheter closure of ASD in patients over 60 years old. SUBJECTS AND METHODS Between May 2006 and December 2011, 31 patients over 60 years old (25 female and 6 male; mean 66.7±5.25 years old, range 61-78 years old) were referred to our center. RESULTS A total of 23 patients underwent therapeutic catheterization to close secundum ASD, and the closure was successful in 22 patients (95.7%). All patients who underwent the procedure survived except for one patient who expired because of left ventricular dysfunction. A small residual shunt was observed in two (9%) of 21 patients before discharge but disappeared at follow-up. All patients eventually had complete closure. There were five patients who had coronary problems. One patient underwent percutaneous coronary intervention using a stent at the same time as transcatheter closure of ASD. Atrial arrhythmias were detected in 6 of 23 patients (26.1%) before the procedure. One patient was successfully treated by radiofrequency ablation before the procedure. No patients displayed new onset arrhythmia during the follow-up period. Follow-up echocardiographic evaluation showed a significantly improved right ventricular geometry. CONCLUSION We conclude that transcatheter closure of ASD is a safe and an effective treatment method for patients over 60 years old if the procedure is performed under a thorough evaluation of comorbidities and risk factors.
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Affiliation(s)
- Saet Byul Woo
- Department of Pediatrics, Hallym University Medical Center, Seoul, Korea
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Mantziari L, Suman-Horduna I, Babu-Narayan SV, Ernst S. Advanced ablation strategies for management of post-surgical atrial arrhythmias. Glob Cardiol Sci Pract 2013; 2013:140-8. [PMID: 24689014 PMCID: PMC3963742 DOI: 10.5339/gcsp.2013.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/22/2013] [Indexed: 11/05/2022] Open
Abstract
Post-surgical arrhythmias include a wide range of arrhythmias occurring late after cardiac surgery and represent a complex substrate for catheter ablation either because of extended scar and remodeling or because of limited access to the area of interest. Novel image integration and ablation tools have made the catheter ablation in this population both feasible and successful. We review a structured approach to catheter ablation of post-surgical atrial arrhythmias in various patient cohorts including the most common congenital heart defects.
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Affiliation(s)
- Lilian Mantziari
- Cardiology Department, Royal Brompton and Harefield Hospital, London, UK
| | | | | | - Sabine Ernst
- Cardiology Department, Royal Brompton and Harefield Hospital, London, UK
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Suman-Horduna I, Ernst S. Remote navigation for ablation of arrhythmias in patients with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2012. [DOI: 10.1016/j.ppedcard.2012.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Barron AJ, Wensel R, Francis DP, Malik I. The role for cardiopulmonary exercise testing in patients with atrial septal defects: A review. Int J Cardiol 2012; 161:68-72. [DOI: 10.1016/j.ijcard.2011.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 08/31/2011] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
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Long-term (5- to 20-year) outcomes after transcatheter or surgical treatment of hemodynamically significant isolated secundum atrial septal defect. Am J Cardiol 2012; 109:1348-52. [PMID: 22335856 DOI: 10.1016/j.amjcard.2011.12.031] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 12/13/2011] [Accepted: 12/13/2011] [Indexed: 11/22/2022]
Abstract
Truly long-term follow-up data after transcatheter closure (TC) of atrial septal defects (ASDs) are scarce. We report the 5- to 20-year outcomes of TC and surgical closure (SC) for typical secundum ASD. We reviewed the records of patients with isolated secundum ASD and right ventricular volume overload who underwent TC or SC (January 1, 1986 to September 30, 2005). Follow-up was obtained through a combination of chart review, physician records, and telephone survey. We identified 375 patients (207 SC and 168 TC) and obtained follow-up data >5 years (median follow-up 10 years) for 300 (152 SC, 148 TC). Nine patients have died (3%). The New York Heart Association functional class was unchanged in 227 patients, improved in 25, and was worse in 15. Clinically significant arrhythmia was found in 28 patients (9.3%); 21% aged >40 years developed arrhythmia. On multivariate analysis, the odds of significant arrhythmia tended to be greater in the SC group, but this was statistically insignificant (95% confidence interval 0.68 to 3.9, p = 0.27). Age and preprocedure arrhythmia, but not TC or SC, were independent risk factors for late arrhythmia (p <0.001). No difference was found in the incidence of late, probably embolic, stroke in the TC (3%) versus SC (2%) groups. In conclusion, long-term outcomes after secundum ASD closure using modern methods are excellent. No significant differences were found between TC versus SC with regard to survival, functional capacity, atrial arrhythmias, or embolic neurologic events. Arrhythmia and neurologic events remain long-term risks after ASD closure, especially if the patient had pre-existing arrhythmia.
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VIJARNSORN CHODCHANOK, DURONGPISITKUL KRITVIKROM, CHANTHONG PRAKUL, CHUNGSOMPRASONG PAWEENA, SOONGSWANG JARUPIM, LOAHAPRASITIPORN DUANGMANEE, NANA APICHART, KURASIRIKUL SURUTHAI, NIMDET KACHAPORN. Beneficial Effects of Transcatheter Closure of Atrial Septal Defects Not Only in Young Adults. J Interv Cardiol 2012; 25:382-90. [DOI: 10.1111/j.1540-8183.2012.00723.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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De Bruaene AV, Delcroix M, Pasquet A, De Backer J, Paelinck B, Morissens M, Budts W. The importance of pulmonary artery pressures on late atrial arrhythmia in transcatheter and surgically closed ASD type secundum. Int J Cardiol 2011; 152:192-5. [DOI: 10.1016/j.ijcard.2010.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/15/2010] [Accepted: 07/03/2010] [Indexed: 10/19/2022]
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Humenberger M, Rosenhek R, Gabriel H, Rader F, Heger M, Klaar U, Binder T, Probst P, Heinze G, Maurer G, Baumgartner H. Benefit of atrial septal defect closure in adults: impact of age. Eur Heart J 2011; 32:553-60. [PMID: 20943671 PMCID: PMC3697806 DOI: 10.1093/eurheartj/ehq352] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 07/12/2010] [Accepted: 08/04/2010] [Indexed: 01/08/2023] Open
Abstract
AIMS To evaluate the effect of age on the clinical benefit of atrial septal defect (ASD) closure in adults. METHODS AND RESULTS Functional status, the presence of arrhythmias, right ventricular (RV) remodelling, and pulmonary artery pressure (PAP) were studied in 236 consecutive patients undergoing transcatheter ASD closure [164 females, mean age of 49 ± 18 years, 78 younger than 40 years (Group A), 84 between 40 and 60 years (Group B) and 74 older than 60 years (Group C)]. Defect size [median 22 mm (inter-quartile range, 19, 26 mm)] and shunt ratio [Qp:Qs 2.2 (1.7, 2.9)] did not differ among age groups. Older patients had, however, more advanced symptoms and both, PAP (r = 0.65, P < 0.0001) and RV size (r = 0.28, P < 0.0001), were significantly related to age. Post-interventionally, RV size decreased from 41 ± 7, 43 ± 7, and 45 ± 6 mm to 32 ± 5, 34 ± 5, and 37 ± 5 mm for Groups A, B, and C, respectively (P < 0.0001), and PAP decreased from 31 ± 7, 37 ± 10, and 53 ± 17 mmHg to 26 ± 5, 30 ± 6, and 43 ± 14 mmHg (P < 0.0001), respectively. Absolute changes in RV size (P = 0.80) and PAP (P = 0.24) did not significantly differ among groups. Symptoms were present in 13, 49, and 83% of the patients before and in 3, 11, and 34% after intervention in Groups A, B, and C. Functional status was related to PAP. CONCLUSIONS At any age, ASD closure is followed by symptomatic improvement and regression of PAP and RV size. However, the best outcome is achieved in patients with less functional impairment and less elevated PAP. Considering the continuous increase in symptoms, RV remodelling, and PAP with age, ASD closure must be recommended irrespective of symptoms early after diagnosis even in adults of advanced age.
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Affiliation(s)
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Harald Gabriel
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Florian Rader
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Maria Heger
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Ursula Klaar
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Binder
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Peter Probst
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Heinze
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Gerald Maurer
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Helmut Baumgartner
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
- Adult Congenital and Valvular Heart Disease Center,Department of Cardiology and Angiology, University of Muenster, Albert Schweitzer Str. 33, 48149 Muenster, Germany
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Teh AW, Medi C, Lee G, Rosso R, Sparks PB, Morton JB, Kistler PM, Halloran K, Vohra JK, Kalman JM. Long-term outcome following ablation of atrial flutter occurring late after atrial septal defect repair. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:431-5. [PMID: 21208243 DOI: 10.1111/j.1540-8159.2010.03005.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS In patients with surgical atrial septal defect (ASD) repair, late atrial flutters (AFLs), including cavotricuspid isthmus (CTI)-dependent and non-CTI-dependent scar-related flutter (AFL), are common. Radiofrequency ablation (RFA) of these arrhythmias has a high acute success rate. We aimed to characterize the long-term freedom from atrial arrhythmias in this population. METHODS Twenty consecutive patients undergoing RFA for AFL late after ASD repair were included. Electrophysiological assessment included multipolar activation, entrainment, and electroanatomic mapping. Clinical, electrocardiograph, and Holter monitoring follow-up was conducted every 6 months. RESULTS Mean age was 53 ± 13 years. Time from surgical repair to RFA was 29 ± 15 years. All patients had CTI-dependent AFL (20/20). There were 1.6 ± 0.7 arrhythmias per patient; other arrhythmias included non-CTI-dependent AFL (14), focal atrial tachycardia (two), and atrioventricular nodal reentry tachycardia (two) . Acute success was obtained in 100%. Five patients with recurrent AFL (three CTI dependent, two non-CTI dependent) at 13 ± 8 months had successful repeat RFA. At 3.2 ± 1.6 years follow-up since the last procedure, 90% of patients with successful RFA for AFL remained free of their clinical arrhythmia. However, 30% of the original 20 patients had documented atrial fibrillation (AF) 2.1 ± 1.6 years after the last procedure; five (25%) required AF intervention. One stroke (5%) occurred in the context of late AF. CONCLUSION RFA of AFL occurring late after surgical ASD repair has a low long-term risk of recurrence, although 25% of patients required two procedures. However, there is a high late incidence of AF (30%), with an additional 25% of patients requiring intervention for AF.
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Affiliation(s)
- Andrew W Teh
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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Cheng TO. Prevention of postoperative atrial fibrillation and/or flutter is another important reason for percutaneous instead of surgical closure of atrial septal defect in adults. Int J Cardiol 2010; 145:215. [PMID: 19556017 DOI: 10.1016/j.ijcard.2009.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 04/14/2009] [Indexed: 11/30/2022]
Affiliation(s)
- Tsung O Cheng
- The George Washington University, Medical Center, 2150 Pennsylvania Avenue, N.W., Washington, D.C. 20037, United States.
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Morgan G, Lee KJ, Chaturvedi R, Benson L. A biodegradable device (BioSTAR™) for atrial septal defect closure in children. Catheter Cardiovasc Interv 2010; 76:241-5. [DOI: 10.1002/ccd.22517] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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