Abstract
Atrial septal defect (ASD) is a condition that requires early intervention because of the consequences over the right-side heart. Chronic atrial stretching promotes atrial conduction delay and the imbalance of the conduction homogeneity, which lead to the propensity to atrial arrhythmias (AA). We aim to evaluate the impact of transcatheter closure of ASD on atrial vulnerability markers leading to late AA in young adults. We conducted a prospective, longitudinal study in one hundred patients (mean age 25.2 ± 5.4 years) who underwent transcatheter closure of ASD at Cardiocentro Pediátrico William Soler. P-wave maximum (Pmax) and P-wave dispersion (Pd) were analyzed from 12-lead electrocardiogram. Left-side and right-side intraatrial and interatrial electromechanical delay (EMD) were measured with tissue Doppler imaging. Both electrocardiographic and echocardiographic analyses were performed during the study period. Compared to baseline, there was a significant reduction in P max (p ≤ 0.001) and Pd (p ≤ 0.001) after 3 months of procedure. All atrial electromechanical coupling parameters significantly reduced at 6 months of ASD closure and tend to remain at lower values till the last evaluation. Over 9.2 ± 1.6 years of follow-up, 15 subjects (15%) developed AA, of which intraatrial reentrant tachycardia (66.6%) became the main rhythm disturbance. Intra-right atrial EMD ≥ 16 ms (HR 4.08, 95% CI 1.15–14.56; p = 0.03) and Pd 45 ms (HR 1.66, 95% CI 1.06–2.59; p = 0.02) were identified as predictors of late AA. Transcatheter device closure of ASD in young adults promotes a significant reduction of electrocardiographic and echocardiographic markers of AA vulnerability, which persist during the long-term follow-up. Nevertheless, Pd and interatrial EMD were identified as independent risk factors of AA.
Similar content being viewed by others
References
Durongpisitkul K, Soongswang J, Laohaprasitiporn D et al (2002) Comparison of atrial septal defect closure using Amplatzer septal occluder with surgery. Pediatr Cardiol 23:36–40
Petit CJ, Justino H, Pignatelli RH et al (2013) Percutaneous atrial septal defect closure in infants and toddlers: predictors of success. Pediatr Cardiol 34:220–225
Love BA, Collins KK, Walsh EP, Triedman JK (2001) Electroanatomic characterization of conduction barriers in sinus/atrially paced rhythm and association with intra-atrial reentrant tachycardia circuits following congenital heart disease surgery. J Cardiovasc Electrophysiol 12:17–25
Morton JB, Sanders P, Vohra JK et al (2003) Effect of chronic right atrial stretch on atrial electrical remodeling in patients with an atrial septal defect. Circulation 107:1775–1782
Cui QQ, Zhang W, Wang H et al (2008) Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clin Cardiol 31:74–78
Wong T, Davlouros PA, Li W et al (2004) Mechano-electrical interaction late after Fontan operation: relation between P-wave duration and dispersion, right atrial size, and atrial arrhythmias. Circulation 109:2319–2325
Magnani JW, Mazzini MJ, Sullivan LM et al (2010) P-wave indices, distribution and quality control assessment (from the Framingham Heart Study). Ann Noninvasive Electrocardiol 15:77–84
van der Hulst AE, Roest AAW, Holman ER et al (2012) Relation of prolonged tissue Doppler imaging-derived atrial conduction time to atrial arrhythmia in adult patients with congenital heart disease. Am J Cardiol 109(12):1792–1796
Takahashi S, Katayama K, Watanabe M et al (2016) Preoperative tissue Doppler imaging-derived atrial conduction time predicts postoperative atrial fibrillation in patients undergoing mitral valve surgery for mitral valve regurgitation. Circ J 80:101–109
Ho TF, Chia EL, Yip WC et al (2001) Analysis of P wave and P dispersion in children with secundum atrial septal defect. Ann Noninvasive Electrocardiol 6:305–309
Baspinar O, Sucu M, Koruk S et al (2011) P-wave dispersion between transcatheter and surgical closure of secundum type atrial septal defect in childhood. Cardiol Young 21:15–18
Grignani RT, Tolentino KM, Rajgor DD, Quek SC (2015) Longitudinal evaluation of P-wave dispersion and P-wave maximum in children after transcatheter device closure of secundum atrial septal defect. Pediatr Cardiol 36:1050–1056
Guray U, Guray Y, Mecit B et al (2004) Maximum p wave duration and p wave dispersion in adult patients with secundum atrial septal defect: the impact of surgical repair. Ann Noninvasive Electrocardiol 9:136–141
Gatzoulis M, Freeman M, Siu SC, Webb GD, Harris L (1999) Atrial arrhythmias after surgical closure of atrial septal defects in adults. N Engl J Med 11:839–846
Roos-Hesselink JW, Meijboom FJ, Spitaels SE et al (2003) Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. A prospective follow-up study of 21–33 years. Eur Heart J 24:190–197
Van De Bauaene A, Moons P, Belmans A et al (2013) Predictive model for late atrial arrhythmia after closure of an atrial septal defect. Int J Cardiol 164:318–322
Silversides CK, Siu SC, McLaughlin PR et al (2004) Symptomatic atrial arrhythmias and transcatheter closure of atrial septal defects in adult patients. Heart 2004(90):1194–1198
Cagdas M, Velibey Y, Guvenc TS, Gungor B, Guzelburc O, Calik N et al (2015) Evaluation of atrial electromechanical conduction delay in case of hemodynamically insignificant rheumatic heart disease: a tissue Doppler study. Cardiology J 6:683–690
Bengi Bakal R, Hatipoglu S, Sahin M et al (2014) Determinants of atrial electro- mechanical delay in patients with functional mitral regurgitation and non- ischemic dilated cardiomyopathy. J Cardiovasc Thorac Res 6:241–246
Fang F, Luo XX, Lin QS et al (2013) Characterization of mid-term atrial geometrical and electrical remodeling following device closure of atrial septal defects in adults. Int J Cardiol 168:467–471
Atas H, Cansel M, Kurtoglu E, Pekdemir H, Ozdemir R (2017) Effects of the transcatheter closure of atrial septal defect on electrocardiographic and echocardiographic parameters six months after the closure. Med Sci 6:213–216
Bolens M, Friedli B (1984) Sinus node function and conduction system before and after surgery for secundum atrial septal defect: an electrophysiologic study. Am J Cardiol 53:1415–1420
Bink-Boelkens MT, Bergstra A, Landsman ML (1988) Functional abnormalities of the conduction system in children with an atrial septal defect. Int J Cardiol 20:263–272
Bulut M, Evlice M, Celik M et al (2017) Atrial electromechanical delay in patients undergoing heart transplantation. J Arrhythm 33:122–126
Erturk M, Aslan M, Aksu HU et al (2013) Evaluation of atrial electromechanic delay and left atrial mechanical functions in the patients with secundum type atrial septal defect. Echocardiography 30:699–705
Aslan M, Erturk M, Turen S et al (2014) Effects of percutaneous closure of atrial septal defect on left atrial mechanical and conduction functions. Eur Heart J 15:1117–1124
Öz A, Aruğaslan E, Çınar T et al (2018) Long term evaluation of electromechanical delay in patients with atrial septal defect after transcatheter closure. Int J Cardiovasc Imaging. https://doi.org/10.1007/s10554-018-1426-x
Nakagawa H, Shah N, Matsudaira K et al (2001) Characterization of reentrant circuits in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease. Isolated channels between scars allow “focal” ablation. Circulation 103:699–709
Akar JG, Kok LC, Haines DE, DiMarco JP, Mounsey JP (2001) Coexistence of type I atrial flutter and intra-atrial re-entrant tachycardia in patients with surgically corrected congenital heart disease. J Am Coll Cardiol 38:377–384
Fukunami M, Yamada T, Ohmori M et al (1991) Detection of patients at risk for paroxysmal atrial fibrillation during sinus rhythm by P wave-triggered signal averaged electrocardiogram. Circulation 83:162–169
Merckx KL, De Vos CB, Palmans A et al (2005) Atrial activation time determined by transthoracic Doppler tissue imaging can be used as an estimate of the total duration of atrial electrical activation. J Am Soc Echocardiogr 18:940–944
Park KM, Hwang JK, Chun KJ et al (2016) Prediction of early-onset atrial tachyarrhythmia after successful transcatheter device closure of atrial septal defect. Medicine 95:35
Favilli S, Zuppiroli A, Mori F et al (1999) Should the patient with an interatrial defect recognized in adulthood always be operated on? G Ital Cardiol 29:1302–1307
Avila P, Oliver JM, Gallego P et al (2017) Natural history and clinical predictors of atrial tachycardia in adults with congenital heart disease. Circ Arrhythm Electrophysiol 10:e005396. https://doi.org/10.1161/CIRCEP.117.005396
Sideris DA, Toumanidis ST, Thodorakis M et al (1994) Some observations on the mechanism of pressure related atrial fibrillation. Eur Heart J 15:1585–1589
Shinagawa K, Li D, Leung TK, Nattel S (2002) Consequences of atrial tachycardia-induced remodeling depend on the preexisting atrial substrate. Circulation 105:251–257
Li D, Melnyk P, Feng J et al (2000) Effects of experimental heart failure on atrial cellular and ionic electrophysiology. Circulation 101:2631–2638
Boyden PA, Hoffman BF (1981) The effects on atrial electrophysiology and structure of surgically induced right atrial enlargement in dogs. Circ Res 49:1319–1331
Ueda A, Adachi I, McCarthy KP et al (2013) Substrates of atrial arrhythmias: histological insights from patients with congenital heart disease. Int J Cardiol 168:2481–2486
Demir K, Avci A, Kaya Z et al (2016) Assessment of atrial electromechanical delay and P-wave dispersión in patients with type 2 diabetes mellitus. J Cardiol 67:378–383
Tuluce K, Ozerkan F, Yakar Tuluce S et al (2015) Relationships between P wave dispersion, atrial electromechanical delay, left atrial remodeling, and NT-proBNP levels, in patients with hypertrophic cardiomyopathy. Cardiol J 22:94–100
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declared that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ortega, M.C., Ramos, D.B.B., Novoa, J.C.R. et al. Impact of Transcatheter Device Closure of Atrial Septal Defect on Atrial Arrhythmias Propensity in Young Adults. Pediatr Cardiol 41, 54–61 (2020). https://doi.org/10.1007/s00246-019-02221-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-019-02221-0