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Dehn AM, Pærregaard MM, Sellmer A, Dannesbo S, Blixenkrone-Møller E, Sillesen AS, Raja AA, Iversen KK, Bundgaard H, Christensen AH, Hjortdal V. Electrocardiographic Characteristics in 438 Neonates with Atrial Septal Defects. Pediatr Cardiol 2024; 45:580-587. [PMID: 37914855 PMCID: PMC10891263 DOI: 10.1007/s00246-023-03324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023]
Abstract
Arrhythmias and electrocardiographic (ECG) abnormalities are common among patients with atrial septal defects (ASDs). We studied a large cohort of neonates with ASDs to investigate whether ECG abnormalities are present at this early stage or develop later, secondary to hemodynamic changes. We analyzed the echocardiograms and ECGs from the Copenhagen Baby Heart Study, a population-based cohort study. We compared ECG characteristics of 438 neonates with secundum ASDs to 1314 matched controls. In subgroup analyses, we investigated whether electrocardiographic characteristics were associated with age at examination. Neonates with ASDs (median age, 11 days; males, 51%) had longer P-wave durations (58 vs. 56 ms, p < 0.001), PR intervals (100 vs. 96 ms, p < 0.001), and a more rightward-shifted QRS axis (116 vs. 114 degrees, p = 0.032) compared to controls (median age, 10 days; males, 51%). There were no differences between cases and controls in the P-wave area, amplitude, or axis. Subgroup analyses showed that the differences in P-wave duration and PR interval were present in neonates examined in the first week after birth. The difference in the QRS axis was not found in neonates examined this early but was found in neonates examined at age two to four weeks. In conclusion, ASDs are associated with ECG changes from the neonatal phase. The P-wave duration and PR interval are longer in neonates with ASDs when compared to controls as early as the first week after birth, indicating that these changes are not purely secondary, but that neonates with an ASD have altered cardiac electrical activity.ClinicalTrials.gov Identifier NCT02753348 (April 27, 2016).
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Affiliation(s)
- Anna Maria Dehn
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Maria Munk Pærregaard
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Sellmer
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Sofie Dannesbo
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anne-Sophie Sillesen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Fumanelli J, Garibaldi S, Castaldi B, Di Candia A, Pizzuto A, Sirico D, Cuman M, Mirizzi G, Marchese P, Cantinotti M, Piacenti M, Assanta N, Viacava C, Di Salvo G, Santoro G. Mid-Term Electrical Remodeling after Percutaneous Atrial Septal Defect Closure with GCO Device in a Pediatric Population. J Clin Med 2023; 12:6334. [PMID: 37834978 PMCID: PMC10573535 DOI: 10.3390/jcm12196334] [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: 07/02/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND AIM The GORE® CARDIOFORM (GCO) septal occluder is an atrial septal defect/patent foramen ovale closure device with theoretical advantages over other commercialized devices thanks to its softness and anatomical compliance. Our aim was to evaluate the short- and medium-term electrocardiographic changes after percutaneous ASD closure with GCO in a pediatric population. METHODS We enrolled 39 patients with isolated ASD submitted to trans-catheter closure from January 2020 to June 2021. ECG was performed before, at 24 h and 6 months after the procedure. P wave dispersion, QTc and QTc dispersion were calculated. ECG Holter was recorded at 6 months after implantation. RESULTS Patients' age and body surface area (BSA) were 8.2 ± 4.2 years and 1.0 ± 0.3 m2 respectively. At the baseline, mean P wave dispersion was 40 ± 15 msec and decreased at 24 h (p < 0.002), without any further change at 6 months. At 24 h, PR conduction and QTc dispersion significantly improved (p = 0.018 and p < 0.02 respectively), while the absolute QTc value considerably improved after 6 months. During mid-term follow-up, QTc dispersion remained stable without a significant change in PR conduction. The baseline cardiac frequency was 88.6 ± 12.6 bpm, followed by a slight reduction at 24 h, with a further amelioration at 6 months after the procedure (87.3 ± 14.2, p = 0.9 and 81.0 ± 12.7, p = 0.009, respectively). After device deployment, two patients developed transient, self-limited junctional rhythm. One of them needed a short course of Flecainide for atrial ectopic tachycardia. No tachy/brady-arrhythmias were recorded at the 6-month follow-up. ASD closure resulted in a marked decrease in right heart volumes and diameters at 6 months after percutaneous closure. CONCLUSIONS Percutaneous ASD closure with the GCO device results in significant, sudden improvement of intra-atrial, atrio-ventricular and intraventricular electrical homogeneity. This benefit persists unaltered over a medium-term follow-up. These electrical changes are associated with a documented positive right heart volumetric remodeling at mid-term follow-up.
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Affiliation(s)
- Jennifer Fumanelli
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Silvia Garibaldi
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Electrophysiology Division, 56124 Pisa, Italy
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
| | - Biagio Castaldi
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Angela Di Candia
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Alessandra Pizzuto
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
| | - Domenico Sirico
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Magdalena Cuman
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
| | - Gianluca Mirizzi
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Electrophysiology Division, 56124 Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Marcello Piacenti
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Electrophysiology Division, 56124 Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Cecilia Viacava
- Fondazione G. Monasterio CNR-Regione Toscana, Pediatric Cardiology and Cardiac Surgery, 56124 Pisa, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Woman's and Child's Health Department, Padua University, 35122 Padova, Italy
| | - Giuseppe Santoro
- Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", 54100 Massa, Italy
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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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Sahebjam M, Toofaninejad N, Ajam A, Hosseini K, Jalali A, Zoroufian A. Assessment of Left Ventricular Function and Mitral Regurgitation Severity Early After Percutaneous Device Closure of the Atrial Septal Defect. Crit Pathw Cardiol 2022; 21:30-35. [PMID: 34907937 DOI: 10.1097/hpc.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atrial septal defect (ASD) is one the most prevalent forms of congenital heart disease in adults. Closure of ASDs eliminates left-to-right shunt and reduces right heart volumes, but the effects of ASD closure, on the left ventricle (LV) and mitral valve competence are somewhat inconsistent. Therefore, we designed this study to evaluate the early effect of percutaneous closure of ASD on LV function and mitral regurgitation (MR) severity. METHODS In this prospective study, we enrolled 32 patients with ASD secundum who underwent percutaneous device closure in Tehran Heart Center. We used transthoracic and transesophageal echocardiography (TEE) before the procedure and TTE 24 hours after the procedure, then compared obtained LV parameters before and after the procedure. RESULTS LV end-diastolic diameter (LVEDD) increased significantly from 44.8 ± 2.4 to 45.8 ± 2.8 (P < 0.001). LV end-systolic diameter (LVESD) also increased but was statistically insignificant (P = 0.063) and LV ejection fraction (LVEF) remained nearly unchanged. Highest alteration was in right ventricular systolic pressure (12.4% decrease; P < 0.001) and mitral early Doppler/tissue Doppler velocity ratio (E/E') (9.7% increase; P = 0.010). The change in MR severity was insignificant using Wilcoxon signed-rank test (P = 0.157). CONCLUSIONS We concluded that systolic functions do not change immediately. However, LVEDD and E/E' will increase immediately, resulting from the passage of all blood from the LA into the LV in the early diastole just after closure. We also observed the positive effect of device closure on reducing right ventricular systolic pressure, and at least it does not worsen MR early after the procedure.
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Affiliation(s)
- Mohammad Sahebjam
- From the Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Toofaninejad
- From the Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ajam
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Zoroufian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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5
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Van Praagh R. Interatrial Communications. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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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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Predictors of New-Onset Atrial Tachyarrhythmias After Transcatheter Atrial Septal Defect Closure in Adults. Heart Lung Circ 2021; 30:1406-1413. [PMID: 33863668 DOI: 10.1016/j.hlc.2021.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/03/2021] [Accepted: 02/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND New-onset atrial tachyarrhythmia (ATA) often develops after atrial septal defect (ASD) closure. Its development raises some potential concerns such as stroke and bleeding complications caused by anticoagulant therapy and limited access to the left atrium for catheter ablation. Although it is essential to identify the risk factors of new-onset ATA, few studies have examined these factors. This study investigated unknown risk factors for the development of new-onset ATA after transcatheter ASD closure in patients without a history of ATA. METHODS A total of 238 patients without a history of ATA, aged ≥18 years and who underwent transcatheter ASD closure at the current hospital were reviewed. Patient characteristics were compared between the groups with and without new-onset ATA. The factors associated with new-onset ATA were examined using univariate and multivariable analyses. RESULTS Thirteen (13) (5.5%) patients experienced ATA during follow-up (mean, 21±14 months). Compared with patients without new-onset ATA, patients with new-onset ATA were older (48±18 vs 66±11 years; p<0.001) and had high brain natriuretic peptide (BNP) levels (36±36 vs 177±306 pg/mL; p<0.001). On multivariable analysis, BNP ≥40 pg/mL before ASD closure was associated with new-onset ATA after adjusting for age (OR, 4.91; 95% CI, 1.22-19.8; p=0.025). CONCLUSION Patients with BNP levels >40 pg/mL before transcatheter ASD closure may have a higher risk of developing new-onset ATA.
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Evertz R, Reinders M, Houck C, Ten Cate T, Duijnhouwer AL, Beukema R, Westra S, Vernooy K, de Groot NMS. Atrial fibrillation in patients with an atrial septal defect in a single centre cohort during a long clinical follow-up: its association with closure and outcome of therapy. Open Heart 2020; 7:openhrt-2020-001298. [PMID: 32817255 PMCID: PMC7437693 DOI: 10.1136/openhrt-2020-001298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Currently, consensus is lacking on the relation between closure of atrial septal defect (ASD) and the incidence of atrial fibrillation (AF), which is a known complication in ASD patients. More importantly, studies reporting on the treatment applied for AF in ASD patients are scarce. The aims of this study were (1) to assess the incidence of AF in ASD patients, (2) to study the relation between closure and AF and (3) to evaluate applied treatment strategies. Methods A single-centre retrospective study in 173 patients with an ASD was performed. We analysed the incidence of AF, the relation of AF with closure, method of closure and the treatment success of therapies applied. Results Almost 20% of patients with an ASD developed AF, with a mean age of 59 (±14) years at first presentation of AF during a median clinical follow-up of 43 (29–59) years. Older age (OR 1.072; p<0.001) and a dilated left atrium (OR 3.727; p=0.009) were independently associated with new-onset AF. Closure itself was not independently associated with AF. First applied treatment strategy was rhythm control in 77%. Of the 18 patients treated with antiarrhythmic drugs 50% had at least 1 recurrence of AF. Conclusion No clear relation between closure of the ASD and AF could be assessed. This is the first study describing applied therapy for AF in ASD patients of which medical rhythm control was the most applied strategy with a disappointing efficacy.
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Affiliation(s)
- Reinder Evertz
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Manon Reinders
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Charlotte Houck
- Cardiology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Tim Ten Cate
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Rypko Beukema
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sjoerd Westra
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kevin Vernooy
- Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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P wave dispersion in assessment of dysrhythmia risk in patients with secundum type atrial septal defect and the effect of transcatheter or surgical closure. Cardiol Young 2020; 30:263-270. [PMID: 31854289 DOI: 10.1017/s1047951119002828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atrial dysrhythmia is an important cause of mortality and morbidity in patients with atrial septal defect. Increased P wave duration can predict the risk of atrial dysrhythmia. The aim of this study is to evaluate the risk of atrial dysrhythmia by measuring P wave dispersion, and to observe the effect of surgical and transcatheter closure. Sixty-one patients and 30 controls were investigated. In patient group, before and after closure and in control group at the time of presentation, 12-lead electrocardiography records were evaluated. P wave duration and amplitude, P wave axis, PR interval, P wave dispersion, QRS axis, corrected QT interval, and QT dispersion were calculated. The measurements in patient and control groups, measurements before and after closure, and measurements of surgical and transcatheter group were compared. There were 27 patients in surgical group and 34 patients in transcatheter group. In patient group, signs of right heart volume overload were apparent but there was no significant difference in terms of P wave dispersion between two groups. We compared patient group in itself and found that while the use of medication, cardiothoracic index, ratio of right ventricular dilation, and paradoxical movement in interventricular septum were increased, mean age of closure was younger in surgical group. While P wave dispersion decreased in transcatheter group after closure, it increased in surgical group (p = 0.021). In conclusion, atrial septal defects may cause atrial repolarisation abnormalities and this effect persists even after surgical closure. Transcatheter closure in childhood may decrease dysrhythmia risk in long-term follow-up.
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Suzuki K, Kato T, Koyama S, Shinohara T, Inukai S, Sato J, Yamamoto H, Omori D, Yoshida S, Takeda S, Nishikawa H, Ohashi N, Sakurai H, Saitoh S. Influence of Percutaneous Occlusion of Atrial Septal Defect on Left Atrial Function Evaluated Using 2D Speckle Tracking Echocardiography. Int Heart J 2020; 61:83-88. [PMID: 31956134 DOI: 10.1536/ihj.19-173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Percutaneous occlusion of atrial septal defect (ASD) has recently become a standard therapeutic strategy, but little is known about left atrial (LA) function thereafter. The present study aimed to determine LA function in 43 children with ASD and 13 controls based on LA strain measured by two-dimensional echocardiographic speckle tracking (2DE-ST). Among these children, 12 underwent surgery (ASD-S), 31 had device closure (ASD-D), and 13 were included as controls. LA strain was significantly decreased after ASD-D but was not significantly altered after ASD-S, indicating that percutaneous occlusion of an ASD might decrease LA function. Furthermore, the size of the ASD device negatively correlated with LA strain. These results imply that ASD occlusion devices negatively influence LA function and might be important when decided therapeutic strategies for ASD. LA strain measured by 2DE-ST should become a good indicator of LA function after ASD treatment in children.
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Affiliation(s)
- Kazutaka Suzuki
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences
| | - Taichi Kato
- Department of Pediatrics, Nagoya University Graduate School of Medicine
| | - Satoshi Koyama
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences
| | - Tsutomu Shinohara
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences
| | - Sachiko Inukai
- Department of Pediatrics, Nagoya Daini Red Cross Hospital
| | - Jun Sato
- Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Children Heart Center
| | - Hidenori Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine
| | | | - Shuichiro Yoshida
- Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Children Heart Center
| | - Sho Takeda
- Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Children Heart Center
| | - Hiroshi Nishikawa
- Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Children Heart Center
| | - Naoki Ohashi
- Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Children Heart Center
| | - Hajime Sakurai
- Cardiovascular Surgery, Japan Community Healthcare Organization Chukyo Children Heart Center
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences
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Nakagawa K, Akagi T, Nagase S, Takaya Y, Kijima Y, Toh N, Watanabe A, Nishii N, Nakamura K, Morita H, Kusano K, Ito H. Efficacy of catheter ablation for paroxysmal atrial fibrillation in patients with atrial septal defect: a comparison with transcatheter closure alone. Europace 2019; 21:1663-1669. [DOI: 10.1093/europace/euz207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
There is no valid treatment strategy for addressing paroxysmal atrial fibrillation (AF) in patients with unclosed atrial septal defect (ASD). We aimed to assess the efficacy of catheter ablation (CA) compared with transcatheter ASD closure alone for treating pre-existing paroxysmal AF in patients with ASD.
Methods and results
Among 908 patients who underwent transcatheter ASD closure, we evaluated 50 consecutive patients (63 ± 12 years) with paroxysmal AF. We compared the AF outcomes of these patients after transcatheter ASD closure between those with and without CA prior to ASD closure. Thirty (60%) patients underwent CA. During the follow-up period after ASD closure (mean: 49 ± 23 months), recurrence of AF was observed in 6/30 (20%) patients with upfront CA and 12/20 (60%) patients with ASD closure alone. Kaplan–Meier analysis showed that the AF-free survival rate was significantly higher for patients with CA than for those with ASD closure alone (79% vs. 37% at 5 years, P = 0.002). Upfront CA and previous heart failure hospitalization were associated with recurrence of AF after ASD closure [hazard ratio (HR) 0.18, 95% confidence interval (CI) 0.06–0.53; P = 0.002 and HR 4.64, 95% CI 1.60–13.49; P = 0.005, respectively].
Conclusion
In ASD patient with paroxysmal AF, transcatheter ASD closure alone demonstrated high AF recurrence rate after ASD closure. On the other hand, upfront CA prior to ASD closure substantially suppressed AF recurrence over the long term. A combination of CA and transcatheter ASD closure may be a feasible treatment strategy for paroxysmal AF in patients with ASD.
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Affiliation(s)
- Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan
| | - Satoshi Nagase
- Department of Cardiac Arrhythmias, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan
| | - Yasufumi Kijima
- Department of Cardiovascular Medicine, Cardiovascular Center, St. Luke’s International Hospital, Tokyo, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan
| | - Kengo Kusano
- Department of Cardiac Arrhythmias, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, Japan
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Takaya Y, Akagi T, Kijima Y, Nakagawa K, Ito H. Functional Tricuspid Regurgitation After Transcatheter Closure of Atrial Septal Defect in Adult Patients. JACC Cardiovasc Interv 2017; 10:2211-2218. [DOI: 10.1016/j.jcin.2017.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/05/2017] [Accepted: 06/15/2017] [Indexed: 11/26/2022]
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13
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Benefit of ASD closure in different age groups. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0527-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lednev PV, Belov YV, Komarov RN, Stonogin AV, Katkov AI. [Sinus rhythm restoration after left atrial reduction]. Khirurgiia (Mosk) 2017:80-82. [PMID: 28303878 DOI: 10.17116/hirurgia2017280-82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- P V Lednev
- Petrovsky Russian Research Center of Surgery
| | - Yu V Belov
- Petrovsky Russian Research Center of Surgery; Sechenov First Moscow State Medical University, Moscow, Russia
| | - R N Komarov
- Department of Cardiac surgery, Clinic of Aortic and Cardiovascular Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - A I Katkov
- Department of Cardiac surgery, Clinic of Aortic and Cardiovascular Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
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Clinically apparent long-term electric disturbances in the acute and very long-term of patent foramen ovale device-based closure. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:118-122. [DOI: 10.1016/j.carrev.2016.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 11/22/2022]
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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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17
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Catheter closure of atrial septal defect in the elderly (≥ 65 years). A worthwhile procedure. Int J Cardiol 2016; 218:25-30. [DOI: 10.1016/j.ijcard.2016.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/22/2016] [Accepted: 05/12/2016] [Indexed: 11/21/2022]
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Ucak A, Temizkan V, Ugur M, Yedekci AE, Uz O, Selcuk A, Yilmaz AT. Comparison of primary repair and patch plasty procedure on the P wave in adult atrial septal defect closure. Cardiovasc J Afr 2016; 27:285-261. [PMID: 27149297 PMCID: PMC5340896 DOI: 10.5830/cvja-2016-013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/17/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction: In this study we compared the effects of two different surgical procedures for closure of adult atrial septal defect (ASD) on postoperative P-wave changes. Methods: Patients who underwent cardiac surgery for secundum type ASD closure were evaluated retrospectively. Seventy-two patients with primary repair of ASD and 29 patients with pericardial patch plasty repair were compared according to Pmax, Pmin and P-wave dispersions (Pd). Results: In each group, the increases in postoperative maximum P-wave duration (Pmax) and minimum P-wave duration (Pmin) were statistically significant. There was no statistically significant difference between post- and pre-operative Pd values. In the comparison between group 1 and group 2 in terms of postoperative P-wave changes (Pmax, Pmin, Pd) there was no statistically significant difference. Conclusion: Comparing patch plasty and primary repair for the surgical closure of ASD in the early to mid-postoperative period, no difference was found and both surgical procedures can be performed in adult ASDs.
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Affiliation(s)
- Alper Ucak
- Department of Cardiovascular Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
| | - Veysel Temizkan
- Department of Cardiovascular Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Murat Ugur
- Department of Cardiovascular Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ahmet Erturk Yedekci
- Department of Cardiovascular Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Omer Uz
- Department of Cardiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Arif Selcuk
- Department of Cardiovascular Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
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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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McLeod CJ, Asirvatham SJ, Warnes CA, Ammash NM. Device therapy for arrhythmia management in adults with congenital heart disease. Expert Rev Med Devices 2014; 7:519-27. [DOI: 10.1586/erd.10.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Ozyilmaz I, Ozyilmaz S, Tola HT, Saygi M, Kiplapinar N, Tanıdır C, Ergul Y, Guzeltas A, Odemis E. Holter electrocardiography findings and P-wave dispersion in pediatric patients with transcatheter closure of atrial septal defects. Ann Noninvasive Electrocardiol 2013; 19:174-81. [PMID: 24620845 DOI: 10.1111/anec.12104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aimed to determine the frequency of postintervention arrhythmia and factors associated with the development of arrhythmia, including the correlation between arrhythmia and P-wave dispersion, and the effects of the latter on transcatheter closure of atrial septal defects (ASDs). METHODS Holter ECG recordings were performed before and after the intervention and 6 and 12 months later in 47 of the 59 patients who had undergone transcatheter ASD closure and once in the healthy control subjects. RESULTS A statistically significant correlation was identified between the patients' arrhythmia grade according to Lown's system and each of the following: the number of defects, the size of the atrioventricular valve rim, the presence of an atrial septal aneurysm. CONCLUSION The frequency of arrhythmia increases after transcatheter ASD closure, gradually decreases within the next year, and is most frequently of a benign nature. Lown's arrhythmia grading of patients occluded with either the Amplatzer septal occluder (ASO) or the Cardio-O-Fix septal occluder (CSO) were compared, and the arrhythmia frequency was higher with the latter. One day after the intervention, the P maximum (Pmax ) and the P dispersion(Pdis ) values were not increased but in fact slightly reduced in patients occluded with either ASO or CSO. An improvement in the electrical system resulting from early anatomical and mechanical healing following transcatheter ASD occlusion may explain the reduction in the Pmax and Pdis values.
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22
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Nitta T, Sakamoto SI, Miyagi Y, Fujii M, Ishii Y, Ochi M. Reentrant and Focal Activations During Atrial Fibrillation in Patients With Atrial Septal Defect. Ann Thorac Surg 2013; 96:1266-1272. [DOI: 10.1016/j.athoracsur.2013.05.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/19/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
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23
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Noble S, Ibrahim R. Percutaneous atrial septal defect closure in patients with left ventricle failure or pulmonary hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2012. [DOI: 10.1016/j.ppedcard.2012.08.009] [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: 12/01/2022]
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24
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Tsai SF, Kalbfleisch S. The Management of Atrial Fibrillation in a Patient with Unrepaired Atrial Septal Defect. Card Electrophysiol Clin 2012; 4:127-33. [PMID: 26939809 DOI: 10.1016/j.ccep.2012.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation (AF) is a frequent comorbidity in adults with atrial septal defect (ASD), one of the most common congenital heart defects. However, there are currently limited recommendations for the management of AF associated with ASD. This article describes a case using a planned approach of catheter ablation followed by transcatheter device closure and discusses management options.
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Affiliation(s)
- Shane F Tsai
- Division of Cardiovascular Medicine, The Ohio State University, Suite 200, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Columbus, OH 43210, USA
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Nakagawa K, Akagi T, Taniguchi M, Kijima Y, Goto K, Kusano KF, Itoh H, Sano S. Transcatheter closure of atrial septal defect in a geriatric population. Catheter Cardiovasc Interv 2012; 80:84-90. [DOI: 10.1002/ccd.23457] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 10/29/2011] [Indexed: 11/06/2022]
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Abstract
Atrial septal defect (ASD) is the most common type of common congenital heart disease (CHD) in adults. During the last decade, there has been a remarkable change in the treatment strategy of ASD, shifting the therapeutic gold standard from surgery to transcatheter closure, along with refinements and the evolution of device technology. Reports on the outcome of transcatheter ASD closure have shown an excellent efficacy as well as a low complication rate. However, the procedural details and/or outcomes of this procedure may be influenced by several factors including morphologic characteristics of the defect, co-morbid diseases, as well as individual factors including age and weight of the patient. Because the risk-benefit relationship in both the very young and the elderly subsets of the patients has not been clearly defined yet, closure of an ASD with device may be potentially subtracted from the treatment option in these patient groups. In this article, we will review the basis for device closure in small children and elderly patients with ASD and provide an overview of the frequently encountered problems.
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Affiliation(s)
- Nam Kyun Kim
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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27
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28
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Effects of age on hemodynamic changes after transcatheter closure of atrial septal defect: importance of ventricular diastolic function. Heart Vessels 2011; 27:71-8. [DOI: 10.1007/s00380-011-0122-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
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29
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P-wave dispersion between transcatheter and surgical closure of secundum-type atrial septal defect in childhood. Cardiol Young 2011; 21:15-8. [PMID: 20920379 DOI: 10.1017/s1047951110001307] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with atrial septal defect have an increased risk for atrial fibrillation. Increased P-wave dispersion predicts the development of atrial fibrillation. The aim of this study was to determine difference in P dispersion between transcatheter closure with Amplatzer septal occluder and surgical closure in childhood. A total of 68 children (the mean age was 7.2 plus or minus 3.3 years; the mean secundum atrial septal defects diameter was 17.3 plus or minus 5.4 millimetres) were evaluated in this study. Transcatheter closure was attempted in 41 children with secundum atrial septal defects, and the defect in 27 patients was closed by surgical techniques. P maximum, P minimum and P dispersion were measured by the 12-lead surface electrocardiography. P maximum, P minimum and P dispersion were found to be similar in patients with pre- and post-procedure (98.0 plus or minus 19.3 versus 95.1 plus or minus 23.0 milliseconds; 68.0 plus or minus 20.8 versus 67.6 plus or minus 24.3 milliseconds, 29.9 plus or minus 11.0 versus 27.1 plus or minus 12.1 milliseconds, respectively). There was no statistical significance in the comparison of P dispersion between the two groups. But in the surgical group, P-wave dispersion was decreased more significantly compared with baseline values (p-value equal to 0.03). In conclusion, there is no P dispersion between transcatheter closure with Amplatzer septal occluder and surgical closure of secundum atrial septal defect.
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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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Giardini A, Donti A, Sciarra F, Bronzetti G, Mariucci E, Picchio FM. Long-term incidence of atrial fibrillation and flutter after transcatheter atrial septal defect closure in adults. Int J Cardiol 2009; 134:47-51. [DOI: 10.1016/j.ijcard.2008.02.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 01/14/2008] [Accepted: 02/14/2008] [Indexed: 11/27/2022]
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Thilén U, Carlson J, Platonov P, Olsson S. Atrial myocardial pathoelectrophysiology in adults with a secundum atrial septal defect is unaffected by closure of the defect. A study using high resolution signal-averaged orthogonal P-wave technique. Int J Cardiol 2009; 132:364-8. [DOI: 10.1016/j.ijcard.2007.11.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
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Matsutani N, Lee R, O’Leary J. Thoracoscopic Pulmonary Vein Isolation After Previous Percutaneous Atrial Septal Defect Closure. J Card Surg 2008; 23:727-8. [DOI: 10.1111/j.1540-8191.2008.00687.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Noriyuki Matsutani
- Department of Surgery II, National Defense Medical College, Namiki, Tokorozawa, Saitama, Japan
| | - Richard Lee
- Division of Cardiothoracic Surgery, Northwestern University, Galter, Chicago, Illinois
| | - Jennifer O’Leary
- Division of Cardiothoracic Surgery, Northwestern University, Galter, Chicago, Illinois
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Spies C, Khandelwal A, Timmermanns I, Schräder R. Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults. Am J Cardiol 2008; 102:902-6. [PMID: 18805119 DOI: 10.1016/j.amjcard.2008.05.045] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Revised: 05/16/2008] [Accepted: 05/16/2008] [Indexed: 12/28/2022]
Abstract
Transcatheter closure of secundum atrial septal defect (ASD) and patent foramen ovale (PFO) has become a routine procedure. Little is known about the effect of atrial septal device implantation on the occurrence of atrial fibrillation (AF). We evaluated the frequency of AF occurring after transcatheter PFO and ASD closure in a large population. From 1994 until 2007 a total of 1,062 patients underwent transcatheter closure of an interatrial communication. New-onset AF was defined by 12-lead electrocardiogram or Holter monitoring in patients without a history of AF at baseline. Of the 1,062 patients, 822 had a PFO and 240 had an ASD. During a median follow up of 20 months, new-onset AF was documented in 8% of patients. New-onset AF occurred in 7% of patients after PFO closure and in 12% of patients with underlying ASD. The annual incidence of new-onset AF was 2.5% and 4.1% in patients with PFO and ASD, respectively. Generally, patients with new-onset AF were older than those without AF. Device type or size did not influence the occurrence of AF. In the group of patients with PFO, residual shunt was more common in patients with AF compared with the non-AF group. In conclusion, AF is more common after PFO and ASD closure compared with the general population; although device type or size did not impact the occurrence of AF, residual shunt may influence the occurrence of AF after intervention in patients with underlying PFO.
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Affiliation(s)
- Christian Spies
- Section of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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Blake GE, Lakkireddy D. Atrial Septal Defect and Atrial Fibrillation: The Known and Unknown. J Atr Fibrillation 2008; 1:45. [PMID: 28496588 DOI: 10.4022/jafib.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 05/19/2008] [Accepted: 08/25/2008] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is a common complication in patients with atrial septal defects (ASDs). The link between AF and ASD is fairly complex and entails modifications in electrophysiologic, contractile and structural properties, at the cellular and tissue level, of both atria, mainly due to chronic atrial stretch and dilation. Surgical repair or percutaneous closure of ASDs are equally effective in reducing mortality and symptoms but limited in preventing or curbing AF, unless combined with an arrhythmia-specific procedure. Transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) have improved the safety and success of the above procedures. Finally, clearer understanding of the pathophysiology of AF in patients with ASD (and CHF, in general) has led to target-specific advances in medical management.
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Affiliation(s)
- George E Blake
- Mid America Cardiology @ University of Kansas Hospital, Kansas City, KS
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Santoro G, Pascotto M, Caputo S, Gaio G, Iacono C, Caso I, Sarubbi B, Carrozza M, Russo MG, Calabrò R. Short-term electrogeometric atrial remodelling after percutaneous atrial septal defect closure. J Cardiovasc Med (Hagerstown) 2008; 9:789-93. [DOI: 10.2459/jcm.0b013e3282f4c87b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yavuz T, Nisli K, Oner N, Dindar A, Aydogan U, Omeroglu RE, Ertugrul T. The effects of surgical repair on P-wave dispersion in children with secundum atrial septal defect. Adv Ther 2008; 25:795-800. [PMID: 18670742 DOI: 10.1007/s12325-008-0081-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Atrial septal defect (ASD) is one of the most common congenital heart diseases in children. P-wave dispersion has been reported to be associated with non-homogeneous propagation of sinus impulses. The heterogeneity of atrial conduction time may predispose the atria to arrhythmias. The aim of this study was to determine the impact of surgical repair on P-wave indices in children with isolated secundum ASD. METHODS Children with isolated secundum ASD undergoing surgical repair (n=50; mean age, 7.0+/-3.0 years) and healthy controls (n=51; mean age, 7.6+/-2.7 years) were compared. Maximum P-wave duration (Pmax), shortest duration (Pmin) and P-wave dispersion (Pd) were measured using 12-lead surface electrocardiography. RESULTS Mean Pmax was found to be significantly higher in children with ASD compared with controls (95.2+/-10.8 vs 84.1+/-9.2 msec; P<0.001), and Pd before surgery was significantly higher compared with controls (47.4+/-12.0 vs 38.8+/-9.7 msec; P<0.001). Both P-wave indices were significantly decreased within the first year after surgical closure - the values decreased to those comparable to healthy controls (Pmax, 86.2+/-9.7 msec; Pd, 39.8+/-10.7 msec; P>0.05). CONCLUSION Surgical closure of ASD in children decreases Pmax and P-wave conduction time. We speculate that earlier closure of the defect may play an important role in avoiding permanent changes in the atrial myocardium and atrial fibrillation in adulthood.
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Affiliation(s)
- Taner Yavuz
- Department of Paediatrics, Duzce Faculty of Medicine, Duzce, Turkey.
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Silversides CK, Haberer K, Siu SC, Webb GD, Benson LN, McLaughlin PR, Harris L. Predictors of atrial arrhythmias after device closure of secundum type atrial septal defects in adults. Am J Cardiol 2008; 101:683-7. [PMID: 18308021 DOI: 10.1016/j.amjcard.2007.10.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 10/12/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
Abstract
Atrial tachyarrhythmias (ATs) contribute substantially to morbidity in adult patients with secundum atrial septal defects (ASDs). The purpose of this study was to prospectively determine the incidence of AT in adults with an ASD and identify predictors of AT occurrence after closure. This was a prospective study of 200 adult patients undergoing closure of a secundum ASD. Arrhythmic events were defined as sustained or symptomatic AT requiring treatment. Twenty percent of patients (mean age 50 +/- 17 years; 26% men) referred for ASD closure had a history of AT. Early follow-up was available for 90% of patients, and the prevalence of AT was 17%. Of 171 patients with late follow-up (mean 1.9 +/- 0.9 years), data were available for 90%. AT was detected in 16% of these patients. Closure resulted in alleviation of symptoms (p <0.001), but symptoms alone did not identify patients at risk of recurrent AT. After closure of the ASD, the likelihood of remaining arrhythmia free was highest in patients without a history of AT (p = 0.001) and those <40 years at closure (p = 0.04). In conclusion, transcatheter ASD closure in patients without a history of arrhythmias and those <40 years of age conferred the highest likelihood of a patient remaining arrhythmia free in follow-up. An arrhythmia-specific treatment strategy should be considered for patients with documented established AT before ASD closure, in addition to shunt relief.
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Di Salvo G, Drago M, Pacileo G, Rea A, Carrozza M, Santoro G, Bigazzi MC, Caso P, Russo MG, Carminati M, Calabro' R. Atrial Function After Surgical and Percutaneous Closure of Atrial Septal Defect: A Strain Rate Imaging Study. J Am Soc Echocardiogr 2005; 18:930-3. [PMID: 16153516 DOI: 10.1016/j.echo.2005.01.029] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Indexed: 12/01/2022]
Abstract
The effect of operation and the effect of the imposition of an occluding device on atrial function for patients with an atrial septal defect (ASD) has never been studied. Thus, the aim of this study was to evaluate for the first time both left atrial (LA) and right atrial (RA) function of children after transcatheter ASD closure with that of sex- and age-matched patients with surgically treated ASD, and sex- and age-matched control subjects using strain (epsilon) and epsilon rate imaging (SR). In all, 45 participants formed our studied sample: 15 patients after successful ASD device closure (ASD-D [atrial septal defect device closure] group, mean age: 9 +/- 3 years) and 15 age- and sex-matched patients after successful ASD surgical closure (ASD-S [atrial septal defect surgical closure] group, mean age: 9 +/- 3 years). All patients underwent ASD correction at least 6 months before the study. As a control group we selected 15 age- and sex-matched control subjects. In the ASD-S group the peak systolic epsilon and SR values were significantly reduced in both RA and LA when compared with control and ASD-D groups (P < .01). In the ASD-D group there was no significant difference in both LA and RA deformation properties when compared with control subjects. SR imaging indexes could provide new, noninvasive, clinically relevant insight on regional changes in atrial function for patients with ASD. ASD percutaneous closure is useful not only because it is less expensive and invasive than open-heart operation but also for its conservation of both LA and RA regional myocardial properties.
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Affiliation(s)
- Giovanni Di Salvo
- Physiopathology of the Cardio-Respiratory System and Associated Biotechnologies, Second University of Naples, Naples, Italy.
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Salehian O, Horlick E, Schwerzmann M, Haberer K, McLaughlin P, Siu SC, Webb G, Therrien J. Improvements in cardiac form and function after transcatheter closure of secundum atrial septal defects. J Am Coll Cardiol 2005; 45:499-504. [PMID: 15708694 DOI: 10.1016/j.jacc.2004.10.052] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 10/16/2004] [Accepted: 10/25/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We set out to study the effect of transcatheter closure of atrial septal defect (ASD) on right ventricular (RV) and left ventricular (LV) function assessed by myocardial performance index (MPI), as well as left atrial (LA) volumes. BACKGROUND The hemodynamic response to the closure of ASD is well-documented in surgically treated patients. However, few studies have documented echocardiographic evaluation of ventricular function in patients undergoing transcatheter closure of ASDs. METHODS Pre- and post-ASD device closure echocardiograms of 25 consecutive patients were retrospectively reviewed. Measurements of RV and LV MPI and LA volumes were made. RESULTS Twenty-five patients with an average age of 45.5 +/- 16.3 years underwent transcatheter closure of ASD. There was statistically significant improvement in RV MPI (0.35 to 0.28, p = 0.004), LV MPI (0.37 to 0.31, p = 0.04), and LA volume index (25.7 to 21.8 ml/m(2), p < 0.001) after closure of ASD. CONCLUSIONS Device closure of ASDs leads to improvement of both RV and LV function as well as reduction in LA volume. These hemodynamic improvements provide insights into the symptomatic benefits gained in closure of ASDs using the transcatheter approach.
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Affiliation(s)
- Omid Salehian
- Toronto Congenital Center for Adults and Echocardiography Laboratory, University of Toronto, Ontario, Canada
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Guray U, Guray Y, Mecit B, Yilmaz MB, Sasmaz H, Korkmaz S. Maximum p wave duration and p wave dispersion in adult patients with secundum atrial septal defect: the impact of surgical repair. Ann Noninvasive Electrocardiol 2004; 9:136-41. [PMID: 15084210 PMCID: PMC6932273 DOI: 10.1111/j.1542-474x.2004.92532.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients with atrial septal defect (ASD) have an increased risk for atrial fibrillation (AF). Previously it was shown that maximum P wave duration and P wave dispersion in 12-lead surface electrocardiograms are significantly increased in individuals with a history of paroxysmal AF. We studied P maximum and P dispersion in adult patients with ASD during normal sinus rhythm. In addition, the impact of surgical closure of ASD on these variables within 1 year after surgery was evaluated. METHODS Thirty-four patients (21 women, 13 men; mean age: 35 +/- 11 years) operated on for ostium secundum type ASD and 24 age-matched healthy subjects (13 women, 11 men; mean age: 37 +/- 10 years) were investigated. P maximum, P minimum, and P dispersion (maximum - minimum P wave duration) were measured from the 12-lead surface electrocardiography. RESULTS P maximum was found to be significantly longer in patients with ASD as compared to controls (115.2 +/- 9 vs 99.3 +/- 14 ms; P < 0.0001). In addition, P dispersion of the patients was significantly higher than controls (37 +/- 9 vs 29.8 +/- 10 ms; P = 0.003). P minimum was not different between the two groups (P = 0.074). After surgical repair of ASD, 10 patients (29%) experienced one or more episodes of paroxysmal AF. Patients with postoperative AF were older (45 +/- 6 vs 30 +/- 10 years; P = 0.001), and had a higher preoperative pulmonary artery peak systolic pressure as compared to those without postoperative AF (51 +/- 11 vs 31 +/- 9 mmHg; P < 0.0001). No significant difference in the pulmonary-to-systemic flow ratio was observed preoperatively between the two groups (P = 0.56). P maximum and P dispersion were significantly higher in patients with postoperative paroxysmal AF at baseline and at postoperative first month, sixth month, and first year as compared to those without it (for P maximum P = 0.027, P = 0.014, P = 0.001, P < 0.0001, respectively; for P dispersion P = 0.037, P = 0.026, P = 0.001, P < 0.0001, respectively). In addition, in patients with postoperative AF, no significant changes were detected in both of these P wave indices during postoperative follow-up. However, in the other group, P maximum and P dispersion were found to be significantly decreased at postoperative 6 months and 1 year as compared to baseline. P minimum was similar throughout the postoperative follow-up as compared to baseline in both groups. CONCLUSIONS Mechanical and electrical changes in atrial myocardium may cause greater P maximum and P dispersion in patients with ASD. Surgical closure of the ASD can regress these pathological changes of atrial myocardium with a result in decreased P maximum and P dispersion. However, higher P maximum and P dispersion at baseline, which have not decreased after surgery, may be associated with postoperative paroxysmal AF, especially for older patients.
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Affiliation(s)
- Umit Guray
- Yüksek Ihtisas Hospital, Cardiology Clinic, Ankara, Turkey.
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Erbay AR, Yilmaz MB, Balci M, Sabah I. Atrial natriuretic peptide levels in adult patients before and after surgery for correction of atrial septal defects: relationship with atrial arrhythmias. Clin Sci (Lond) 2004; 107:297-302. [PMID: 15142035 DOI: 10.1042/cs20040141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Accepted: 05/13/2004] [Indexed: 11/17/2022]
Abstract
In the present study, we have examined whether increased N-ANP (N-terminal pro-ANP) levels before and after surgery in patients with ASD (atrial septal defect) along with echocardiographic findings provide a better insight into the pathophysiology and increased morbidity and mortality following corrective surgery. Eighteen adult ASD patients (>20 years of age; six male and 12 female) with shunts (Qp/Qs≥2, where Qp/Qs is the pulmonary blood flow/systemic blood flow) had complete echocardiographic, clinical and laboratory parameters evaluated before and 6 months after surgery. Eight age- and sex-matched individuals (three male and five female) were enrolled as a control group. Blood samples for N-ANP analysis were obtained in both groups. N-ANP levels in the peripheral blood sample from ASD patients before surgery were significantly higher than those in the control group. In patients with ASD, mean N-ANP levels obtained from the pulmonary artery were significantly higher than that obtained from the peripheral vein. RA (right atrial) area, adjusted for body surface area, and RA long-axis and short-axis measurements were significantly higher in the patient group than the control group. N-ANP was correlated significantly with these parameters. Following corrective surgery, N-ANP values and RA area, RA long-axis and short-axis normalization decreased significantly and were accompanied by a decrease in systolic mean pulmonary artery pressure. N-ANP levels were normalized following septal closure in most patients, except in those with atrial fibrillation attacks following corrective surgery. In conclusion, we have shown correlations among variables indicating changes in the architecture of the right atrium along with temporal changes in ANP providing insights into the pathophysiology of post-operative atrial arrhythmias.
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Affiliation(s)
- Ali R Erbay
- Cardiology Clinic, Yuksek Ihtisas Hospital, Sihhiye, Ankara, Turkey
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Romano MA, Bach DS, Pagani FD, Prager RL, Deeb GM, Bolling SF. Atrial reduction plasty Cox maze procedure: extended indications for atrial fibrillation surgery. Ann Thorac Surg 2004; 77:1282-7; discussion 1287. [PMID: 15063252 DOI: 10.1016/j.athoracsur.2003.06.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Cox maze procedure yields good results for atrial fibrillation (AF). However, patients with predictors of failure-chronic long-standing AF, low amplitude fibrillatory waves, and large left atriums-are generally thought not to benefit from a maze procedure. We report an aggressive approach for these patients, utilizing biatrial reduction plasty concomitantly with the Cox maze procedure for AF. METHODS A complete Cox maze procedure utilizing supplemental RF ablation was performed in 36 patients. All underwent resection of both atrial appendages and biatrial reduction plasty encompassing resection of the left atrial posterior wall from left to right pulmonary veins and from inferior pulmonary veins to the mitral annulus, as well as removal of the right atrial lateral wall. Mitral or tricuspid valve repair, or both, was performed on 32 patients. RESULTS These patients had a mean AF duration of 45 +/- 89 months. Their preoperative left atria measured 66 +/- 16 mm, with mean AF waves of 0.74 +/- 0.3 mm. Mean preoperative New York Heart Association class was 2.7 +/- 0.7 and left ventricular ejection fraction was 48 +/- 9. Cross clamp and bypass times were 91 +/- 35 minutes and 124 +/- 33 minutes, respectively. The average posterior left atrial tissue resected was 5.4 x 2.1 cm, and mean resected atrial weight was 10.3 +/- 2 g. There were no deaths and length of stay was 5.5 +/- 2 days. At a follow-up time of 19 +/- 16 months, 32 of the 36 patients were in normal sinus rhythm and New York Heart Association class I. CONCLUSIONS Aggressive biatrial reduction plasty Cox maze procedure was effective in 89% of these "low success" AF patients. This simple procedure can extend utilization of the Cox maze procedure to more patients with chronic AF.
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Affiliation(s)
- Matthew A Romano
- Section of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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Tanaka M, Berul CI, Ishii M, Jay PY, Wakimoto H, Douglas P, Yamasaki N, Kawamoto T, Gehrmann J, Maguire CT, Schinke M, Seidman CE, Seidman JG, Kurachi Y, Izumo S. A mouse model of congenital heart disease: cardiac arrhythmias and atrial septal defect caused by haploinsufficiency of the cardiac transcription factor Csx/Nkx2.5. COLD SPRING HARBOR SYMPOSIA ON QUANTITATIVE BIOLOGY 2003; 67:317-25. [PMID: 12858555 DOI: 10.1101/sqb.2002.67.317] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M Tanaka
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Guray U, Guray Y, Yýlmaz MB, Mecit B, Sasmaz H, Korknaz S, Kutuk E. Evaluation of P wave duration and P wave dispersion in adult patients with secundum atrial septal defect during normal sinus rhythm. Int J Cardiol 2003; 91:75-9. [PMID: 12957732 DOI: 10.1016/s0167-5273(02)00598-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Paroxysmal atrial arrhythmias especially atrial fibrillation (AF) are frequently encountered in adult patients with atrial septal defect (ASD). Previously it was shown that maximum P wave duration and P wave dispersion in 12-lead surface electrocardiograms are significantly increased in individuals with a history of paroxysmal AF. The aim of this study was to determine whether P maximum and P dispersion in adult patients with ASD and without AF are increased as compared to healthy controls. In addition, the relationship of pulmonary to systemic flow ratio (Qp/Qs) and these P wave indices were investigated. METHODS AND RESULTS Sixty-two consecutive patients [39 women, 23 men; mean age 33+/-13 years (range 16 to 61 years)] with ostium secundum type ASD and 47 healthy subjects [25 women, 22 men; mean age 36.6+/-9.5 years (range 18 to 50 years)] were investigated. P maximum, P minimum and P dispersion (maximum minus minimum P wave duration) were measured from the 12-lead surface ECG. There were no significant differences with respect to age (P=0.08), gender (P=0.3), heart rate (P=0.3), left atrial diameter (P=0.5) and left ventricular ejection fraction (P=0.3) between patients and controls. Pulmonary artery peak systolic pressure was significantly higher in patients with ASD as compared to controls (P<0.0001). P maximum was significantly longer in patients with ASD as compared to controls (P<0.0001). In addition, P dispersion of the patients was significantly higher than controls (P=0.001). P minimum was not different between groups (P=0.12). Mean Qp/Qs of the patients with ASD was 2.5+/-0.7 (minimum 1.5; maximum 4.1) and found to be significantly correlated with P maximum (r=0.34; P=0.006) and P dispersion (r=0.61; P<0.0001). CONCLUSIONS Prolongation of P maximum and increased P dispersion could represent mechanical and electrical changes of atrial myocardium in patients with ASD. These changes of atrial myocardium may be more prominent with higher left to right shunt volumes.
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Affiliation(s)
- Umit Guray
- Yuksek Ihtisas Hospital, Cardiology, Ankara, Turkey.
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Woods WA, Schutte DA, McCulloch MA. Care of children who have had surgery for congenital heart disease. Am J Emerg Med 2003; 21:318-27. [PMID: 12898491 DOI: 10.1016/s0735-6757(03)00042-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Children who have had surgical correction for congenital heart disease can present to the ED with an acute illness that could be associated with their cardiac lesion. There is no data available to summarize complications that could be associated with surgically corrected congenital heart disease. This work was undertaken to describe the common procedures used, list known complications of these procedures, and review general management principles in caring for the acutely ill child who has had heart surgery.
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Affiliation(s)
- William A Woods
- Department of Emergency Medicine, PO Box 800699, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Bottio T, Leoni L, Vida V, Stellin G, Casarotto D, Gerosa G. Radiofrequency ablation through a right atrium incision in congenital atrial septal defect. Langenbecks Arch Surg 2003; 388:52-5. [PMID: 12690481 DOI: 10.1007/s00423-003-0356-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2002] [Accepted: 01/16/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND The incidence of atrial fibrillation is similar in the clinical history of patients with atrial septal defect, either surgically corrected and uncorrected. We present an unpublished technique for treating atrial fibrillation by left endocardial radiofrequency ablation through the lone right atrium incision, coupled to atrial septal defect septum primum and secundum closure, thus reducing the surgical trauma related to paraseptal left atrium incision. PATIENTS AND METHODS We treated 2 patients through a lone right atrium incision by radiofrequency ablation because of congenital atrial septal defect and chronic atrial fibrillation. RESULTS The patients after defect closure were weaned off cardiopulmonary bypass in sinus rhythm. The postoperative hospital stay was uneventful and at more than 1 year of follow-up they are still in sinus rhythm. CONCLUSIONS The radiofrequency ablation procedure is possible through the lone right atrium incision, avoiding any further incision and new source of possible bleeding when in presence of interatrial septal defects, and the technique is simple and useful.
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Affiliation(s)
- Tomaso Bottio
- Department of Cardiovascular Surgery, Medical School of Padua, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
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Oliver JM, Gallego P, González AE, Benito F, Sanz E, Aroca A, Mesa JM, Sobrino JA. [Surgical closure of atrial septal defect before or after the age of 25 years. Comparison with the natural history of unoperated patients]. Rev Esp Cardiol 2002; 55:953-61. [PMID: 12236925 DOI: 10.1016/s0300-8932(02)76734-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Surgical closure of an atrial septal defect (ASD) before the age of 25 years has been demonstrated to reduce complications during adulthood. However, the outcome for patients operated after the age of 25 is still debated. METHODS In a retrospective study we examined the outcome of early and late surgical repair of ASD in adults, as compared with the natural evolution of unoperated patients. The study population was 280 patients (mean age 40 18 years) with non-restrictive ASD: 102 patients (group 1) underwent surgery before the age of 25 years, 90 patients (group 2) underwent surgery after the age of 25 years, and 88 unoperated patients were older than 25 years at the time of study (group 3). The variables analyzed were left ventricular systolic function, left atrial dimensions, systolic pulmonary pressure, right ventricular dimensions, the degree of mitral and tricuspid regurgitation, and the prevalence of late atrial fibrillation. RESULTS Left ventricular systolic function and the degree of mitral regurgitation were not statistically different between groups. Compared with the patients in group 2, the patients in group 1 had a significantly lower systolic pulmonary arterial pressure (p < 0.001) and less dilated right ventricle (p < 0.001) and left atrium (p < 0.001). The degree of tricuspid regurgitation (p < 0.001) and prevalence of atrial fibrillation (p < 0.001) were significantly higher in the patients of group 2. Compared with group 3, the patients in group 2 had a significantly lower systolic pulmonary arterial pressure (p < 0.001) and less dilated right ventricle (p < 0.001). However, the left atrial dimensions, degree of tricuspid regurgitation, and prevalence of atrial fibrillation did not differ in a statistically significant way between the two groups. CONCLUSIONS Surgical repair of an atrial septal defect in patients over 25 years of age does not fully prevent hemodynamic deterioration and the development of atrial arrhythmias. Therefore it seems that the surgical closure of ASD before adulthood should be strongly recommended.
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Affiliation(s)
- José M Oliver
- Unidad de Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, Spain.
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