title: Chronotropic impairment after surgical or percutaneous closure of atrial septal defect.
abstract: BACKGROUND
  In previous studies, an attenuated heart rate response to exercise has been noted in patients after surgical closure of atrial septal defect. The aim of this study was to compare the prevalence of chronotropic impairment after surgical and percutaneous closure of atrial septal defect.
  
  
  METHODS
  Thirty-eight pediatric patients who underwent a surgical (group A, n = 18) or transcatheter closure (group B, n = 20) of atrial septal defect in our institution were prospectively included in the study. Treadmill exercise testing was performed using the Bruce walking treadmill protocol to voluntary exhaustion, with continuous monitoring of heart rate and oxygen consumption.
  
  
  RESULTS
  All the children were in sinus rhythm, and had normal values for peak oxygen uptake and endurance time. Exercise heart rate was significantly lower than normal in group A at the end of stage 2 (Z-score = -0.71 +/- SD 1.02), and in both groups at the end of stage 3 (Z-score = -2.06 +/- 1.76 in A and -1.00 +/- 0.71 in B) and at peak exercise (Z-score = -2.78 +/- 2.14 in A and -0.81 +/- 0.75 in B). However, the heart rate response to exercise was significantly less attenuated in group B than in group A. Moreover, maximal heart rate was <-2 SD in 8/18 surgical patients but in no patient of the group B.
  
  
  CONCLUSIONS
  The chronotropic impairment is significantly less important after transcatheter closure of atrial septal defect than after surgical closure. It is an additional argument in favor of the interventional catheterization.
authors.affiliation: Division of Pediatric Cardiology, Queen Fabiola Children's University Hospital (H.U.D.E.R.F.), Free University of Brussels (ULB), Brussels, Belgium. martial.massin@huderf.be
authors.forename: Martial M
authors.initials: MM
authors.lastname: Massin
authors.forename: Hugues
authors.initials: H
authors.lastname: Dessy
authors.forename: Sophie-Guiti
authors.initials: SG
authors.lastname: Malekzadeh-Milani
authors.forename: Karim
authors.initials: K
authors.lastname: Khaldi
authors.forename: Beyhan
authors.initials: B
authors.lastname: Topac
authors.forename: Raymond
authors.initials: R
authors.lastname: Edelman
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D005080:Exercise Test; D017079:Exercise Tolerance; D006339:Heart Rate; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D010101:Oxygen Consumption; D010807:Physical Endurance; D011446:Prospective Studies; D016896:Treatment Outcome