Cardiac Dysrhythmias in Pediatric Patients Before and 1 Year After Transcatheter Closure of Atrial Septal Defects Using the Amplatzer Septal Occluder

Abstract

To prospectively assess the incidence of cardiac dysrhythmias before and after closure of atrial septal defects (ASDs) using the Amplatzer septal occluder (ASO), 24-hour Holter electrocardiograms (ECGs) were performed before and 1 year after the procedure in 23 pediatric patients (9 male and 14 female). Patients' ages ranged from 2 to 15 years (mean, 7.1 years). All had an ASD of the secundum type that was completely closed (n = 22) or had a small residual shunt (n = 1). No preexisting dysrhythmia was present in 22 patients; atrioventricular nodal reentrant tachycardia had been diagnosed in 1 patient. During the observation period, no clinical dysrhythmia occurred. Analysis of the Holter ECGs before the intervention showed regular sinus rhythm in 20 patients and sinus rhythm with intermittent atrial rhythm in 3 patients. Atrial premature complexes (APCs) were detected in 1 patient, and a ventricular couplet was present in 1 patient. The Holter ECG 1 year after the intervention showed sinus rhythm in 18 patients and sinus rhythm with intermittent atrial rhythm in 5 patients. APCs were still observed in 1 patient and seen for the first time in 1 patient; 1 patient and rare ventricular premature complexes. In conclusion, cardiac dysrhythmias on Holter ECG in pediatric patients before and 1 year after transcatheter ASD closure with the ASO device are rare and benign. Regular Holter monitoring seems to be useful in detecting late dysrhythmias.

Holter Electrocardiography Findings and P‐Wave Dispersion in Pediatric Patients with Transcatheter Closure of Atrial Septal Defects

“…Based on this study, it appears that the arrhythmia frequency increases after transcatheter ASD closure, gradually decreases within the following year, and is most frequently of a benign nature. These findings are consistent with earlier studies . However, when considering the published data in addition to our study, one should not forget that an SVT may arise anytime after the procedure.…”

“…Transcatheter closure of secundum ASDs is a safe and feasible procedure. However, recent studies on arrhythmias following occlusion have shown an increase in the frequency of cardiac dysrhythmia in pediatric patients examined by Holter recordings before and after the ASD closure procedure, although such an event remains rare and benign in character . The frequency of symptomatic tachycardia had been indicated as 1.3% (9/708) by Szkutnik et al This study reported symptomatic tachyarrhythmia in four patients between 2 weeks and 4 months after the procedure.…”

Electrocardiographic changes and arrhythmias following percutaneous atrial septal defect and patent foramen ovale device closure

“…However, potential complications of percutaneous device placement can include access difficulties, device embolization or malposition, pericardial effusion secondary to perforation of the atrium or pulmonary veins, or device thrombus formation [10]. Reported electrocardiographic complications include the development of atrial tachyarrhythmias (AT) or heart block, both transient and permanent [10–14].…”

“…The risk of bundle compression in patients with large atrial septal defects, particularly those with deficient anterosuperior rims, may be increased, although this is unknown. Although scattered reports with small cohorts exist [4, 12], a detailed comparison of electrocardiograms (ECGs) and 24‐hr ambulatory (Holter) monitoring in a large cohort of patients before and after percutaneous closure of ASDs and PFOs has not been reported.…”

Atrioventricular block after ASD closure

“…Hessling and colleagues performed 24 hour Holter monitoring before and 1 year after ASD closure using an ASO in 23 paediatric patients. There were no AV conduction disturbances observed in this study 21. In an adult study, the PR interval increased post ASD device closure after a mean follow-up period of 4 years 22…”