title: Improvement in noninvasive electrophysiologic findings in children after transcatheter atrial septal defect closure.
abstract: To evaluate whether transcatheter closure of secundum atrial septal defects (ASD) affected noninvasive electrophysiologic variables in children, we reviewed the pre-procedural and 1-year postprocedural electrocardiograms and Holter recordings of 18 consecutive children referred for ASD closure. Patients included in the study were a mean of 5.0 years old (SD 1.1) and weighed a mean of 17.9 kg (SD 4.1). ASDs had a mean diameter of 14.0 mm (SD 2.4) and average shunt ratio (pulmonary-to-systemic flow) of 2.1:1. One year after occluder device placement, 9 children (50%) had detectable residual shunts by transthoracic echocardiograms, but only 2 (11%) had shunts that were felt to be possibly significant. One or more fractured occluder legs were noted by chest roentgenogram in 15 patients (83%). Electrocardiograms at follow-up demonstrated improvement in right ventricular dilation in 4 of 7 patients, right atrial enlargement in 3 of 4 patients, and 1 degree atrioventricular block in 2 of 3 patients. Holter recordings showed a decreased incidence of accelerated atrial rhythm in 3 of 7 patients, prolonged junctional escape rhythm in 2 of 2 patients, and premature atrial contractions in 2 of 2 patients. No finding correlated with patient age, defect or occluder diameter, occluder leg fracture(s), or residual defects. These improvements in electrophysiologic abnormalities compare favorably with changes seen 1 year after surgical closure. In conclusion, placement of a transcatheter ASD device in children diminishes noninvasive electrophysiologic abnormalities at 1-year follow-up. By relieving hemodynamic stress caused by an ASD in childhood, a transcatheter device may prevent arrhythmia disturbance later in life.
authors.affiliation: Department of Pediatric Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Schenck
authors.forename: R
authors.initials: R
authors.lastname: Sterba
authors.forename: C K
authors.initials: CK
authors.lastname: Foreman
authors.forename: L A
authors.initials: LA
authors.lastname: Latson
mesh_terms: D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D019736:Prostheses and Implants