Atrioventricular block after ASD closure

Abstract

Objective Secundum atrial septal defect (ASD) is a common congenital heart defect. There is limited data on both early and late atrioventricular (AV) block post ASD closure. The aim of this study was to determine the incidence and risk factors of AV block associated with ASD closure. Methods A retrospective analysis of all patients who underwent ASD closure either with a device or surgical method at the Royal Children's Hospital Melbourne between 1996 and 2010 was performed. Baseline demographics, procedural details and follow-up data were collected from medical records. Results A total of 378 patients were identified; 242 in the device group and 136 in the surgical group. Fourteen patients (3.7%) had AV block (1 with second degree and 13 with first degree) at a median follow-up of 28 months; 11/242 (4.5%) in the device group and 3/135 (2.2%) in the surgical group ( p=0.39). Six patients had new-onset AV block after ASD closure. In the device subgroup, patients with AV block at follow-up had a larger indexed device size compared with those without (22 (15-31) vs 18(7-38), p=0.02). Multivariate analysis revealed the presence of AV block either pre procedure or post procedure to be the only variables associated with late AV block. Conclusions Late AV block in patients with repaired ASD is rare and most likely independent of the technique used. In the device subgroup, the only risk factor identified to be associated with late AV block was the presence of either preprocedural or postprocedural AV block, so long-term follow-up for these patients should be provided. BACKGROUND

Pacemaker and conduction disturbances in patients with atrial septal defect

“…Indeed, the prolonged timespan with an open defect and volume overload of the right heart might cause more pronounced right ventricular dilation and, potentially, a greater impact on myocardial and electrical tissue. Supportive of this finding, Asakai et al 17 found in a well-conducted retrospective study that more patients with atrial septal defects developed atrioventricular block late following catheter-based closure (4.5%) when compared to surgical closure (2.2%). It must, however, be noted that only 23 patients of our patients had catheter closure compared to 153 who underwent surgery, making any comparative conclusions difficult.…”

Arrhythmias and conduction disorders associated with atrial septal defects

“…This is likely secondary to the displacement of the AV node and His bundle and the proximity of the defect to these structures (5). AV block in these patients may develop spontaneously over time with no surgical or procedural intervention (21,23). Post-surgical AV block may also develop from injury to the conduction system during patch repair, though this is rare with modern surgical techniques (2,24).…”

“…High-grade AV block from device closure typically occurs in the first 24-hour post-procedure and resolution rate is high if device is removed. Risk factors include young age and large defect/ device size (23).…”

Anatomical Considerations and Emerging Strategies for Reducing New Onset Conduction Disturbances in Percutaneous Structural Heart Disease Interventions

“…In patients with appropriate anatomy and indications for closure, percutaneous devicebased closure of atrial septal defects (ASDs) and ventricular septal defects (VSDs) may be preferred over surgery due to similar efficacy, reduced invasiveness and associated complications, and improved patient satisfaction. [3][4][5] Early clinical experience with transcatheter closure of atrial and ventricular septal defects provided the field of SHD with an introduction to the importance of cardiac electrophysiologic anatomy (Figure 1 and 2). Persistent high-grade AVB requiring PPM implantation appears to be uncommon (~1-5%) with percutaneous ASD [5][6][7][8][9] and VSD [10][11][12][13] closure.…”

“…[3][4][5] Early clinical experience with transcatheter closure of atrial and ventricular septal defects provided the field of SHD with an introduction to the importance of cardiac electrophysiologic anatomy (Figure 1 and 2). Persistent high-grade AVB requiring PPM implantation appears to be uncommon (~1-5%) with percutaneous ASD [5][6][7][8][9] and VSD [10][11][12][13] closure. These observations are limited by a paucity of long-term outcome data in large numbers of patients and the true incidence may be confounded by the fact that many patients with post-closure AVB are frequently converted to surgical closure.…”