Impact of ostium secundum atrial septal defect closure on the resolution of falsely positive electrocardiographic criteria for myocardial scarring.
BACKGROUND
Electrocardiographic (ECG) Selvester QRS score criteria with false indication of anteroseptal scarring consistent with myocardial infarction have been found in patients with ostium secundum atrial septal defect (OS-ASD). The objective of this study was to evaluate ECGs pre and post percutaneous transcatheter OS-ASD closure to test the hypothesis that the falsely positive criteria for anteroseptal scar decline 1 day post procedure.


METHODS
Patients (n = 34, mean age 48 ± 17 years, 79% female) that underwent OS-ASD closure and had undergone pre procedure cardiac magnetic resonance imaging showing no left ventricular (LV) scarring were included in this study. ECGs pre and 1 day post procedure were assessed according to the QRS Selvester scoring system and compared.


RESULTS
Mean Selvester score in anteroseptal regions pre procedure was 6.6 (0.0-6.8) % LV scar and decreased to 4.3 (0.0-6.0) % LV scar one day after the procedure (p = 0.01). Mean Selvester score in lateral regions pre procedure was 3.7 (0.0-3.0) %LV scar and decreased to 2.8 (0.0-0.0) % LV scar one day post procedure (p = 0.25).


CONCLUSIONS
OS-ASD patients with falsely positive anteroseptal scar criteria by the Selvester QRS score pre procedure have a significant decrease in anteroseptal Selvester score 1 day post procedure. The falsely positive anteroseptal scar criteria did not completely resolve 1 day post procedure. Further studies are needed to investigate the relationship between ECG criteria for anteroseptal scar and right ventricular volume overload in late follow up.
Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Duke Clinical Research Institute, Durham, North Carolina, USA.
Frida
F
Sundh
Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Duke Clinical Research Institute, Durham, North Carolina, USA.
Jacob
J
Simlund
Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
J Kevin
JK
Harrison
Department of Health Services, University of Washington, Seattle, Washington, USA.
Charles
C
Maynard
Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Martin
M
Ugander
Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA.
David G
DG
Strauss
Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
Esben
E
Carlsen
Duke Clinical Research Institute, Durham, North Carolina, USA. Electronic address: galen.wagner@duke.edu.
Galen S
GS
Wagner
D002921:Cicatrix / Q000503:physiopathology; D004562:Electrocardiography; D005189:False Positive Reactions; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055989:Septal Occluder Device
Anterior infarct criteria; Atrial septal defect; Electrocardiogram; RV volume overload