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Castaldi B, Santoro G, Di Candia A, Marchese P, Cantinotti M, Pizzuto A, Scalera S, Garibaldi S, Fumanelli J, Sirico D, Di Salvo G. Impact of Gore Cardioform Atrial Septal Defect Occluder on Atrial and Ventricular Electromechanics in a Pediatric Population. Am J Cardiol 2024; 211:259-267. [PMID: 37984644 DOI: 10.1016/j.amjcard.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/17/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Transcatheter closure is the first-line treatment for ostium secundum atrial septal defect (ASD). The GORE Cardioform ASD Occluder (GCA) is potentially innovative compared with other self-centering devices. This study aimed to compare the mechanic changes in atrial and ventricular properties before and after GCA implantation. All consecutive patients aged <18 years who underwent isolated ASD closure with a single GCA device were enrolled from 2 centers. Echocardiography and electrocardiogram were performed the day before, 24 hours, and 6 months after ASD closure. Between January 2020 and February 2021, 70 pediatric patients with ASD were enrolled. The mean age was 7.9 ± 3.9 years, and the mean defect diameter was 17.1 ± 4.5 mm. Global longitudinal strain analysis showed no change in left ventricular longitudinal function (T0 -23.2 ± 2.8%, 24 hours -23.0 ± 2.8%, and 6 months -23.5 ± 2.7%). An early and transient reduction in longitudinal strain was detected in the basal septal segments (T0 -19.8 ± 3.3%, 24 hours -18.7 ± 3.6%, and 6 months -19.2 ± 3.4%), left atrium (T0 41.4 ± 15.3%, 29.2 ± 1.4%, and 39.0 ± 12.9%), and right ventricle (-27.6 ± 5.4%, -23.6 ± 5.0%, and -27.3 ± 4.6) 24 hours after closure, secondary to hemodynamic changes because of flow redirection after ASD closure. Six months after the procedure, only the left atrium showed a mild global longitudinal strain reduction because of the presence of the device within the septum. GCA device had no impact on global and regional ventricular function. Atrial mechanics were preserved, except for the segments covered by the device. This is the first device demonstrating no impact on the left and right ventricular mechanics, irrespective of the device size.
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Affiliation(s)
- Biagio Castaldi
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Univesity of Padua, Italy.
| | - Giuseppe Santoro
- Pediatric Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Angela Di Candia
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Univesity of Padua, Italy
| | - Pietro Marchese
- Pediatric Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | | | - Alessandra Pizzuto
- Pediatric Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Silvia Scalera
- Pediatric Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Silvia Garibaldi
- Pediatric Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Jennifer Fumanelli
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Univesity of Padua, Italy
| | - Domenico Sirico
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Univesity of Padua, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Univesity of Padua, Italy
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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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Abu-Tair T, Martin C, Wiethoff CM, Kampmann C. The Prevalence of and Predisposing Factors for Late Atrial Arrhythmias after Transcatheter Closure of Secundum Atrial Septal Defects in Children. J Clin Med 2023; 12:jcm12113717. [PMID: 37297912 DOI: 10.3390/jcm12113717] [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: 04/19/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND A 24 h Holter study in children after transcatheter secundum ASD (ASD II) closure was conducted to detect the prevalence of defects and/or device-related late atrial arrhythmias (LAAs). ASD II closure with an Amplatzer septal occluder (ASO) is an established procedure. Little is known about LAAs after device implantation. METHODS The eligible participants were children who had undergone ASO implantation, with a follow-up of ≥5 years, as well as one pre- and at least one post-procedural Holter ECG. RESULTS In total, 161 patients (mean age: 6.2 ± 4.3 years), with a mean follow-up of 12.9 ± 3.1 years (range 5-19), were included. A median of four Holter ECGs per patient were available. LAAs occurred before intervention in four patients (2.5%), and it was peri-interventional in four patients (2.5%), sustained in three patients (1.9%), and developed in three patients (1.9%). In patients with pre- and peri-interventional LAAs, the Qp/Qs ratio was higher (6.4 ± 3.9 vs. non-AA: 2.0 ± 1.1 (p = 0.002)) and the IAS/ASO ratio was lower (1.18 ± 0.27 vs. non-AA: 1.7 ± 0.4 (p < 0.001)). The patients with LAAs differed from those without LAAs in their Qp/Qs (6.8 ± 3.5 vs. 2.0 ± 1.3; p < 0.0001) and IAS/ASO ratios (1.14 ± 0.19 vs. 1.73 ± 0.45; p < 0.001). The patients with LAAs had a Qp/Qs ratio ≥2.94:1, and those who developed LAAs had an IAS/ASO ratio <1.15. CONCLUSIONS LAAs occurred in 1.9% of patients and were sustained in another 1.9% of patients but persisted in those with large shunt defects and large occluders in relation to the atrial septal length. The predisposing factors for LAAs after ASD closure were a high Qp/Qs ratio, pre-existing atrial arrhythmias, and a low IAS/ASO ratio.
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Affiliation(s)
- Tariq Abu-Tair
- Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Claudia Martin
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany
| | - Christiane M Wiethoff
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany
| | - Christoph Kampmann
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany
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Seo JS, Park YA, Wi JH, Jin HY, Han IY, Jang JS, Yang TH, Kim DK, Kim DS. Long-Term Left Atrial Function after Device Closure and Surgical Closure in Adult Patients with Atrial Septal Defect. J Cardiovasc Imaging 2020; 29:123-132. [PMID: 33605098 PMCID: PMC8099578 DOI: 10.4250/jcvi.2020.0142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Studies comparing left atrial (LA) function after surgical closure or percutaneous closure in patients with an atrial septal defect (ASD) are lacking. METHODS Between 1 and 3 years after ASD treatment, we retrospectively analyzed the medical records and transthoracic echocardiographic images of patients who had been diagnosed with an ASD after 20 years of age and who had undergone surgical closure (ASD-S) or percutaneous device closure (ASD-D). We measured LA peak systolic, early diastolic, and late diastolic strain values using 2-dimensional (2D) speckle tracking echocardiography (STE) and calculated reservoir, conduit, and contraction strain. RESULTS The reservoir strain value of the ASD-D groups was 25.2% ± 7.4%, which was lower compared to the control group (33.6% ± 5.5%) (p = 0.004). The LA conduit strain and the LA contraction values of the ASD-D group were also lower compared to the control group (−13.8% ± 5.8% vs. −20.4% ± 4.7%, p = 0.034; −11.3% ± 4.2% vs. −13.2% ± 2.5%, p = 0.037, respectively). The reservoir, conduit, and contraction strains of the ASD-S group were 27.8% ± 8.8%, −15.3% ± 6.4%, and −12.5% ± 5.8%, respectively, and were not different from those of the control group or the ASD-D group. CONCLUSIONS The 2D STE is a suitable method for evaluating LA function after ASD closure. Our results demonstrate that 1 year after device closure, the LA reservoir, conduit and contraction function were reduced in ASD-D group compared to healthy controls, while there was no difference between the ASD-S and ASD-D groups.
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Affiliation(s)
- Jeong Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
| | - Young Ah Park
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Jin Hong Wi
- Department of Thoracic and Cardiovascular Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Han Young Jin
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Il Yong Han
- Department of Thoracic and Cardiovascular Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Jae Sik Jang
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Tae Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Dae Kyeong Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Dong Soo Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
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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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Long term evaluation of electromechanical delay in patients with atrial septal defect after transcatheter closure. Int J Cardiovasc Imaging 2018; 35:33-39. [PMID: 30062536 DOI: 10.1007/s10554-018-1426-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
Some studies have been showed that electromechanical delay, which may pose an increased tendency to atrial fibrillation, may prolong in patients with various clinical conditions. In addition, the electromechanical delay in patients with secundum type atrial septal defect (ASD) compared to healthy people have been reported previously. Therefore, in the present study, we prospectively evaluated the mid-term and long-term effects of the transcatheter closure of secundum type ASD on the lateral atrial conduction time (PA), septal PA, tricuspid PA, left and right intra-atrial electromechanical delay (ILeft-EMD and IRight-EMD, respectively) and inter-atrial electromechanical delay (IA-EMD) measured by means of Doppler echocardiography. Our prospective study included a total of 45 secundum type ASD patients who undergone percutaneous transcatheter closure from December 2012 to April 2015. All patients underwent transthoracic echocardiography (TTE) before the closure, at sixth and twelfth months after the closure. In comparison of the EMD sixth months after the device closure, there were statistically significant decrease in lateral PA, septal PA, tricuspid PA, ILeft-EMD, IRight-EMD and IA-EMD compared to pre-device closure values. Twelfth months after the device closure, we also observed statistically significant decrease in lateral PA, septal PA, tricuspid PA, ILeft-EMD, IRight-EMD and IA-EMD compared to 6-month post-device closure values. In the present study, we observed that the atrial EMD improves after device closure and continues to improve after twelfth month following post-device closure.
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Roushdy AM, Attia H, Nossir H. Immediate and short term effects of percutaneous atrial septal defect device closure on cardiac electrical remodeling in children. Egypt Heart J 2018; 70:243-247. [PMID: 30591737 PMCID: PMC6303477 DOI: 10.1016/j.ehj.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/21/2018] [Indexed: 12/03/2022] Open
Abstract
Background The beneficial effects of atrial septal defect (ASD) device closure on electrical cardiac remodeling are well established. The timing at which these effects starts to take place has yet to be determined. Objectives To determine the immediate and short term effects of ASD device closure on cardiac electric remodeling in children. Methods 30 pediatric patients were subjected to 12 lead Electrocardiogram immediately before ASD device closure, 24 h post procedure, 1 and 6 months after. The maximum and minimum P wave and QT durations in any of the 12 leads were recorded and P wave and QT dispersions were calculated and compared using paired T test. Results The immediate 24 h follow up electrocardiogram showed significant decrease in P maximum (140.2 ± 6 versus 130.67 ± 5.4 ms), P dispersion (49.73 ± 9.01 versus 41.43 ± 7.65 ms), PR interval (188.7 ± 6.06 ms versus 182.73 ± 5.8 ms), QRS duration (134.4 ± 4.97 ms versus 127.87 ± 4.44), QT maximum (619.07 ± 15.73 ms versus 613.43 ± 11.87), and QT dispersion (67.6 ± 5.31 versus 62.6 ± 4.68 ms) (P = 0.001). After 1 month all the parameters measured showed further significant decrease with P dispersion reaching 32.13 ± 6 (P = 0.001) and QT dispersion reaching 55.0 ± 4.76 (P = 0.001). These effects were maintained 6 months post device closure. Conclusion Percutaneous ASD device closure can reverse electrical changes in atrial and ventricular myocardium as early as the first 24 h post device closure.
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Affiliation(s)
| | - Hebatalla Attia
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
| | - Heba Nossir
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
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Grignani RT, Tolentino KM, Rajgor DD, Quek SC. Longitudinal evaluation of P-wave dispersion and P-wave maximum in children after transcatheter device closure of secundum atrial septal defect. Pediatr Cardiol 2015; 36:1050-6. [PMID: 25628159 DOI: 10.1007/s00246-015-1119-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/14/2015] [Indexed: 11/25/2022]
Abstract
Transcatheter device closure of the secundum atrial septal defect (ASD) in children prevents atrial arrhythmias in older age. However, the benefits of favourable atrial electrocardiographic markers in these children remain elusive. We aimed to review the electrocardiographic markers of atrial activity in a longitudinal fashion. We retrospectively reviewed longitudinal data of all children who underwent transcatheter device closure at the National University Hospital between 2004 and 2013. The inclusion criteria included the presence of a secundum-type ASD with left to right shunt and evidence of increased right ventricular volume load (Q p/Q s ratio >1.5 and/or right ventricular dilatation). A total of 25 patients with a mean follow-up of 44.7 ± 33.47 (7.3-117.4) months were included. P maximum and P dispersion decreased at 2 months, P amplitude at 1 week and remained so until last follow-up. A positive trend was seen with a correlation coefficient of +0.12 for P maximum, +0.08 for P dispersion and 0.34 for P amplitude. There was a higher baseline P amplitude and P dispersion in patients who were older than 10 years and a non-significant trend to support an increase in both P maximum (71.0 ± 8.8 vs. 73.2 ± 12.7), P dispersion (17.0 ± 6.5 vs. 22.0 ± 11.3) and P amplitude (0.88 ± 0.25 vs. 1.02 ± 0.23) in patients with an ASD more than 15 mm compared with an ASD <15 mm. There is reduction in both P maximum and P dispersion as early as 2 months, which persisted on follow-up. Earlier closure may result in more favourable electrocardiographic results.
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Affiliation(s)
- Robert Teodoro Grignani
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Characterization of mid-term atrial geometrical and electrical remodeling following device closure of atrial septal defects in adults. Int J Cardiol 2013; 168:467-71. [DOI: 10.1016/j.ijcard.2012.09.119] [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: 04/26/2012] [Revised: 09/20/2012] [Accepted: 09/22/2012] [Indexed: 11/21/2022]
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10
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Johnson JN, Marquardt ML, Ackerman MJ, Asirvatham SJ, Reeder GS, Cabalka AK, Cetta F, Hagler DJ. Electrocardiographic changes and arrhythmias following percutaneous atrial septal defect and patent foramen ovale device closure. Catheter Cardiovasc Interv 2011; 78:254-61. [DOI: 10.1002/ccd.23028] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 01/28/2011] [Indexed: 11/10/2022]
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