title: Electrocardiographic changes and arrhythmias following percutaneous atrial septal defect and patent foramen ovale device closure.
abstract: OBJECTIVE
  To compare pre- and post-procedure electrocardiograms (ECGs) in a large cohort of patients after percutaneous closure of atrial septal defect (ASD) and patent foramen ovale (PFO).
  
  
  BACKGROUND
  Percutaneous device closure of ASD or PFO is commonplace. Conduction and rhythm anomalies associated with percutaneous device placement have been reported.
  
  
  METHODS
  We reviewed records for all patients who underwent percutaneous device closure of ASD or PFO at our institution from 1999 to 2008. Pre-procedure ECG and Holter studies were compared to available short term (<2 months after placement) and intermediate follow-up (>2 months) ECG or Holter.
  
  
  RESULTS
  Pre- and post-procedural ECGs were available in 610 patients (305 females, average age 50 ± 18.1 years, range 1-91 years, 384 PFO, 184 ASD, 42 with multiple defects, mean device size 16 mm, range 5-38 mm). We report an incidence of 5.2% (32/610) of arrhythmias in the 4 months following device placement, including 29 patients with atrial tachyarrhythmias (ATs, 22 fibrillation, 7 flutter), 1 with junctional tachycardia, and 2 with heart block. Among other findings, the average P-wave duration was increased on intermediate follow-up as compared to early follow-up (P < 0.001). Development of new-onset 1st degree AV Block after the procedure was associated with an increased risk of ATs post-procedure (P < 0.0001).
  
  
  CONCLUSIONS
  We report a low risk of clinically significant post-procedure arrhythmias after device placement. Clinically significant heart block occurred in only two patients (0.3%). Changes in several markers of atrial conduction were found, suggesting an effect of device closure on intra-atrial conduction.
authors.affiliation: Department of Pediatrics/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Johnson
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Marquardt
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ackerman
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.forename: Guy S
authors.initials: GS
authors.lastname: Reeder
authors.forename: Allison K
authors.initials: AK
authors.lastname: Cabalka
authors.forename: Frank
authors.initials: F
authors.lastname: Cetta
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Hagler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D054092:Foramen Ovale, Patent / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006329:Heart Conduction System / Q000503:physiopathology*; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult