title: Short-term electrogeometric atrial remodelling after percutaneous atrial septal defect closure.
abstract: BACKGROUND
  Atrial arrhythmias are well known long-term complications of atrial septal defect (ASD), presumably due to chronic atrial enlargement and stretch. Surgical repair often fails to revert the arrhythmic risk despite atrial volumetric unloading, maybe as a consequence of atriotomic scar. Avoiding atrial incision, percutaneous ASD closure should result in atrial unloading and arrhythmic risk decrease. This study evaluated the atrial short-term electrogeometric effects of percutaneous ASD closure.
  
  
  METHODS
  Fifteen asymptomatic patients (age 23 +/- 5 years) submitted to percutaneous closure of large ASD (QP/QS 2.4 +/- 0.3) using the Amplatzer Septal Occluder device (24 +/- 2 mm) underwent atrial echocardiographic (indexed right atrial size and left atrial size as well as right atrial/left atrial volume ratio) and electrocardiographic (P-wave duration and dispersion, PR conduction time and dispersion) evaluation at 1 and 6 months after ASD closure.
  
  
  RESULTS
  After 6 months, the indexed right atrial volume and the right atrial/left atrial volume ratio had significantly decreased (from 39 +/- 5 to 20 +/- 2 ml/m2, P < 0.001 and from 2.0 +/- 0.2 to 1.0 +/- 0.1, P < 0.0001, respectively) as did the P-wave dispersion (from 32 +/- 2 to 28 +/- 1 ms, P = 0.03) despite a significant increase of both P-wave maximal (from 75 +/- 3 to 81 +/- 3 ms, P < 0.01) and minimal (from 42 +/- 3 to 53 +/- 3 ms, P < 0.005) duration.
  
  
  CONCLUSIONS
  Percutaneous ASD closure causes a short-term positive atrial electrogeometric remodelling. The electrocardiographic predictors of atrial arrhythmias, however, tend to worsen early after device implantation despite a marked volumetric unloading, possibly due to a 'foreign body' effect of the occluding device. This might warrant a closer follow-up during the first few weeks after device implantation.
authors.affiliation: Division of Cardiology, A.O. Monaldi, 2nd University of Naples, Naples, Italy. santoropino@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santoro
authors.forename: Marco
authors.initials: M
authors.lastname: Pascotto
authors.forename: Salvatore
authors.initials: S
authors.lastname: Caputo
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Gaio
authors.forename: Carola
authors.initials: C
authors.lastname: Iacono
authors.forename: Ilaria
authors.initials: I
authors.lastname: Caso
authors.forename: Berardo
authors.initials: B
authors.lastname: Sarubbi
authors.forename: Marianna
authors.initials: M
authors.lastname: Carrozza
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016275:Atrial Function / Q000502:physiology*; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology*; D013997:Time Factors