Changes of Cardiac Rhythm after Closure of Secundum Atrial Septal Defect in Children

Abstract

Background: Arrhythmias may complicate congenital heart diseases, such as secundum atrial septal defects. We aimed at following up the rhythm changes in children after closure of ostiumsecundum atrial septal defects.
 Methods: The current study was conducted in the Pediatric Cardiology Unit, Tanta University, on 60 pediatric patients who had undergone either trans-catheter or surgical closure of secundum atrial septal defects. Complete history taking and full clinical assessment were done. Echocardiographic assessment was performed to detect any residual defects, and assess chamber dimensions, and cardiac functions. Electrocardiographic assessment including Holter monitoring was performed within two months after the procedure, after six months, and after one year. Arrhythmias were classified into major and minor types. All results were statistically analyzed and tabulated.
 Results: There were no significant differences between the pre-closure rhythm and the rhythm after closure of the defects throughout the follow-up. The percentage of patients with major arrhythmias has increased from 6.7% of the total sample to 13.3%, 11.6%, and 11.6% in the early, midterm and late follow up respectively. The significant risk factors for postoperative arrhythmias were; pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability in the early follow up.
 Conclusions: We concluded that arrhythmias were common before and after atrial septal defect closure, without significant differences. Pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability are considered important risk factors of arrhythmias after secundum atrial septal defect’s closure in pediatric patients.

Arrhythmic Risk and Treatment after Transcatheter Atrial Septal Defect Closure

“…In addition to atrial fibrillation and cavo-tricuspid isthmus (CTI) atrial flutter, other arrhythmias and conduction disorders can develop after percutaneous ASD closure like focal or other re-entrant atrial tachycardias, sinus node dysfunction, and complete heart block. Although atrioventricular reentry tachycardia and non-sustained supraventricular tachycardia are not more common than in the general population, they may have additional challenges in ASD patients when submitted for catheter ablation [ 13 ].…”

“…Also, patients with PFO show a close temporal proximity between AF and occluder placement [ 9 , 18 ]. After the procedure, early-onset arrhythmias in pediatric patients may be related to changes in hemodynamics due to clinical circumstances [ 13 ].…”