Atrioventricular block after transcatheter ASD closure using the Amplatzer septal occluder: risk factors and recommendations.
Transcatheter device closure of atrial septal defects is now considered an alternative option to open heart surgery with good short-term and long-term results (Du et al., J Am Coll Cardiol 2002;39:1836-1844, Chessa et al., J Am Coll Cardiol 2002;39:1061-1065); in comparison with surgical closure, the complication rate is lower (Du et al., J Am Coll Cardiol 2002;39:1836-1844). Arrhythmias are known infrequent complications of device closure. However, complete heart block is a rare complication of both treatment modalities (Chessa et al., J Am Coll Cardiol 2002;39:1061-1065). We report two patients who developed atrioventricular (AV) block within 48 hr after uncomplicated device closure of ASD using the Amplatzer septal occluder (ASO) device. Despite trials of high dose steroids and non-steroidal anti-inflammatory agents in both patients, the response was inadequate and by the end of the first week, both patients were ultimately sent for surgical removal of their devices with complete resolution of their atrioventricular conduction abnormalities. We discuss the possible etiology and risk factors of AV block and propose recommendations for management of such a complication.
Department of Pediatrics and Medicine, Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Illinois 60612, USA.
Shada J
SJ
Al-Anani
Howard
H
Weber
Ziyad M
ZM
Hijazi
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D015716:Electrocardiography, Ambulatory; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D055989:Septal Occluder Device / Q000009:adverse effects*; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D017211:Treatment Failure
D000894:Anti-Inflammatory Agents, Non-Steroidal; D013256:Steroids