title: Resolution of abnormal body surface maps in children with atrial septal defect after intracardiac repair.
abstract: BACKGROUND
  The genesis of repolarization abnormalities of ECG waveforms in atrial septal defect (ASD), which typically is characterized by right ventricular (RV) volume overload, has not been explored, particularly in association with postoperative hemodynamic improvement. The aim of this study was to evaluate the effects of reduced RV overload after ASD closure on depolarization and repolarization abnormalities on body surface maps (BSMs).
  
  
  RESULTS
  BSMs of 14 children with ASD were recorded preoperatively and at early postoperative (1-6 months) and late postoperative (>9 months) stages. BSMs of 31 age-matched healthy children were studied as normal controls. Before intracardiac repair, QRS isopotential maps of children with ASD showed delayed RV breakthrough and subsequent rightward enlargement of the positive area with a maximum shifting to the right. Delayed conduction of the RV, particularly at the outflow tract area, was noted. The preoperative QRST isointegral maps exhibited the two-maximum pattern reflecting repolarization abnormality. The delayed appearance of breakthrough and delayed RV conduction on the QRS isopotential maps persisted from the preoperative to the late postoperative stage, whereas the two-maximum pattern on the QRST isointegral maps normalized to the one-dipole pattern at an early stage after repair.
  
  
  CONCLUSIONS
  Abnormal repolarization parameters in ASD patients showed rapid improvement postoperatively, despite the persistence of depolarization abnormalities. Therefore, the two-maximum pattern on the QRST isointegral maps indicates a primary T wave change due to hemodynamic RV volume overload.
authors.affiliation: Department of Pediatrics, National Defense Medical College, Saitama, Japan. yasano87@me.ndmc.ac.jp
authors.forename: Yuh
authors.initials: Y
authors.lastname: Asano
authors.forename: Naomi
authors.initials: N
authors.lastname: Izumida
authors.forename: Seiko
authors.initials: S
authors.lastname: Kawano
authors.forename: Tohru
authors.initials: T
authors.lastname: Sawanobori
authors.forename: Masayasu
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D000293:Adolescent; D018780:Body Surface Potential Mapping / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000379:methods