Skip to main content

Advertisement

SpringerLink
Log in

Elaborate evaluation of serial changes in electrocardiograms of atrial septal defects after transcatheter closure for a better understanding of the recovery process

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Serial changes of electrocardiograms (ECG) could be used to assess their clinical features in atrial septal defects (ASD) after transcatheter closure together with other clinical parameters. We retrospectively studied 100 ASD patients who underwent transcatheter closure. Complications of persistent atrial fibrillation occurred in five ASD patients, and they were excluded. We divided the other 95 patients according to PQ intervals before closure (normal: < 200 ms, n = 51; prolonged: ≥ 200 ms, n = 44) to evaluate their clinical characteristics and parameters such as echocardiography, chest X-rays, and brain natriuretic protein (BNP) levels. Individuals in the prolonged PQ group were significantly older, had higher incidences of paroxysmal atrial fibrillation (PAF) and heart failure (HF) treated with more β-blockers and diuretics, and with a higher tendency of NYHA functional classification and BNP levels than the normal PQ group. The prolonged PQ group also had a significantly higher incidence of complete right bundle branch block, wider QRS intervals, and larger cardiothoracic ratios in chest X-rays accompanied by larger right atrial-areas and larger left atrial dimensions in echocardiograms. Furthermore, the prolonged PQ intervals with less PQ interval shortening after transcatheter closure revealed that the patients were the oldest at the time of closures and showed less structural normalization of the right heart and left atrium after ASD closure. PAF and HF also occurred more frequently in this subgroup. These results suggested that the ASD patients with prolonged PQ intervals with less PQ shortening were accompanied by more advanced clinical conditions. Together with other clinical parameters, detailed analyses of ECG and their changes after closure could elucidate the clinical characteristics and status of ASD patients with transcatheter closure and were useful for predicting structural normalization after transcatheter closure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hoffman JI, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39:1890–1900

    Article  Google Scholar 

  2. Botto LD, Correa A, Erickson JD (2001) Racial and temporal variations in the prevalence of heart defects. Pediatrics 107:E32

    Article  CAS  Google Scholar 

  3. Hannoush H, Tamim H, Younes H, Arnaout S, Gharzeddine W, Dakik H, Obeid M, Bitar FF (2004) Patterns of congenital heart disease in unoperated adults: a 20-year experience in a developing country. Clin Cardiol 27:236–240

    Article  Google Scholar 

  4. van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, Roos-Hesselink JW (2011) Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 58:2241–2247

    Article  Google Scholar 

  5. Attie F, Rosas M, Granados N, Zabal C, Buendia A, Calderon J (2001) Surgical treatment for secundum atrial septal defects in patients %3e40 years old. A randomized clinical trial. J Am Coll Cardiol 38:2035–2042

    Article  CAS  Google Scholar 

  6. Brochu MC, Baril JF, Dore A, Juneau M, De Guise P, Mercier LA (2002) Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Circulation 106:1821–1826

    Article  Google Scholar 

  7. Nyboe C, Karunanithi Z, Nielsen-Kudsk JE, Hjortdal VE (2018) Long-term mortality in patients with atrial septal defect: a nationwide cohort-study. Eur Heart J 39:993–998

    Article  Google Scholar 

  8. Roos-Hesselink JW, Meijboom FJ, Spitaels SE, van Domburg R, van Rijen EH, Utens EM, Bogers AJ, Simoons ML (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

    Article  CAS  Google Scholar 

  9. Oster M, Bhatt AB, Zaragoza-Macias E, Dendukuri N, Marelli A (2019) Interventional therapy versus medical therapy for secundum atrial septal defect: a systematic review (part 2) for the 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. J Am Coll Cardiol 73:1579–1595

    Article  Google Scholar 

  10. Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF (2019) 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. Circulation 139:e698–e800

    PubMed  Google Scholar 

  11. Humenberger M, Rosenhek R, Gabriel H, Rader F, Heger M, Klaar U, Binder T, Probst P, Heinze G, Maurer G, Baumgartner H (2011) Benefit of atrial septal defect closure in adults: impact of age. Eur Heart J 32:553–560

    Article  Google Scholar 

  12. Varma C, Benson LN, Silversides C, Yip J, Warr MR, Webb G, Siu SC, McLaughlin PR (2004) Outcomes and alternative techniques for device closure of the large secundum atrial septal defect. Catheter Cardiovasc Interv 61:131–139

    Article  Google Scholar 

  13. Takaya Y, Akagi T, Kijima Y, Nakagawa K, Sano S, Ito H (2015) Long-term outcome after transcatheter closure of atrial septal defect in older patients: impact of age at procedure. JACC Cardiovasc Interv 8:600–606

    Article  Google Scholar 

  14. Fang F, Luo XX, Lin QS, Kwong JS, Zhang YC, Jiang X, Yu CM, Lam YY (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

    Article  Google Scholar 

  15. Kamphuis VP, Nassif M, Man SC, Swenne CA, Kors JA, Vink AS, Ten Harkel ADJ, Maan AC, Mulder BJM, de Winter RJ, Blom NA (2019) Electrical remodeling after percutaneous atrial septal defect closure in pediatric and adult patients. Int J Cardiol 285:32–39

    Article  Google Scholar 

  16. Muta H, Akagi T, Egami K, Furui J, Sugahara Y, Ishii M, Matsuishi T (2003) Incidence and clinical features of asymptomatic atrial septal defect in school children diagnosed by heart disease screening. Circ J 67:112–115

    Article  Google Scholar 

  17. Kaya MG, Baykan A, Dogan A, Inanc T, Gunebakmaz O, Dogdu O, Uzum K, Eryol NK, Narin N (2010) Intermediate-term effects of transcatheter secundum atrial septal defect closure on cardiac remodeling in children and adults. Pediatr Cardiol 31:474–482

    Article  Google Scholar 

  18. Veldtman GR, Razack V, Siu S, El-Hajj H, Walker F, Webb GD, Benson LN, McLaughlin PR (2001) Right ventricular form and function after percutaneous atrial septal defect device closure. J Am Coll Cardiol 37:2108–2113

    Article  CAS  Google Scholar 

  19. Khairy P, Marelli AJ (2007) Clinical use of electrocardiography in adults with congenital heart disease. Circulation 116:2734–2746

    Article  Google Scholar 

  20. Di Bernardo S, Berger F, Fasnacht M, Bauersfeld U (2005) Impact of right ventricular size on ECG after percutaneous closure of atrial septal defect with Amplatzer Septal Occluder. Swiss Med Wkly 135:647–651

    PubMed  Google Scholar 

  21. Thilen M, Christersson C, Dellborg M, Mattsson E, Trzebiatowska-Krzynska A, Thilen U (2016) Catheter closure of atrial septal defect in the elderly (%3e/=65years). A worthwhile procedure. Int J Cardiol 218:25–30

    Article  Google Scholar 

  22. Komar M, Przewlocki T, Olszowska M, Sobien B, Stepniewski J, Podolec J, Mleczko S, Tomkiewicz-Pajak L, Zmudka K, Podolec P (2014) Conduction abnormality and arrhythmia after transcatheter closure of atrial septal defect. Circ J 78:2415–2421

    Article  Google Scholar 

  23. Bayar N, Arslan S, Koklu E, Cagirci G, Cay S, Erkal Z, Ayoglu RU, Kucukseymen S (2015) The importance of electrocardiographic findings in the diagnosis of atrial septal defect. Kardiol Pol 73:331–336

    Article  Google Scholar 

  24. Schiller O, Greene EA, Moak JP, Gierdalski M, Berul CI (2013) The poor performance of RSR' pattern on electrocardiogram lead V1 for detection of secundum atrial septal defects in children. J Pediatr 162:308–312

    Article  Google Scholar 

  25. Mostafa S, Abdelhakim A, Aboelazm T, Arafa O, Elemam A (2017) Effect of transcatheter closure of secundum atrial septal defect on cardiac electric remodeling. Int J Heart Rhythm 2:40–48

    Article  Google Scholar 

  26. Gatzoulis MA, Freeman MA, Siu SC, Webb GD, Harris L (1999) Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 340:839–846

    Article  CAS  Google Scholar 

  27. Akagi T (2015) Current concept of transcatheter closure of atrial septal defect in adults. J Cardiol 65:17–25

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the staff members at Kyushu University Hospital for their help with collecting data for this study. This work was supported by a Grant-in-Aid for Scientific Research (B; #18H03083) from the Ministry of Education, Culture, Sports, Science, and Technology, and by an Intractable disease practical application business grant (Grant Numbers 15ek0109123h0001, 16ek0109123h0002, and 17ek0109123h0003) from the Japan Agency for Medical Research and Development.

Author information

Authors and Affiliations

  1. Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Min-Jeong Kang & Kanae Fujita

  2. Department of Health Care for Adults, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Hiroyuki Sawatari

  3. Department of Healthcare Management, College of Healthcare Management, Miyama, Japan

    Hiroaki Chishaki

  4. Nursing Department, Kyushu University Hospital, Fukuoka, Japan

    Ryoji Shinbara

  5. Department of Nursing, Faculty of Health Sciences, Ube Frontier University, Yamaguchi, Japan

    Keiko Yamasaki

  6. Heart Center, Kyushu University Hospital, Fukuoka, Japan

    Tasuku Sato

  7. Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan

    Ichiro Sakamoto, Ken-ichi Hiasa, Ayako Ishikita, Shintaro Umemoto, Mari Nishizaka & Hiroyuki Tsutsui

  8. Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan

    Chizuko A. Kamiya

  9. Department of Cardiology, Cardiovascular Center, St. Luke’s International University Hospital, Tokyo, Japan

    Koichiro Niwa

  10. Health Care Center, Fukuoka Dental College Hospital, Tamura 2-15-1, Sawaraku, Fukuoka, 814-0193, Japan

    Akiko Chishaki

Authors
  1. Min-Jeong Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroyuki Sawatari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroaki Chishaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryoji Shinbara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Keiko Yamasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tasuku Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kanae Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ichiro Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ken-ichi Hiasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ayako Ishikita
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shintaro Umemoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mari Nishizaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hiroyuki Tsutsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Chizuko A. Kamiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Koichiro Niwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Akiko Chishaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by M-J K, HS, RS, KY, TS, and KF. The first draft of the manuscript was written by M-J K, HC, and AC. All authors contributed to the study conception and design, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Akiko Chishaki.

Ethics declarations

Conflict of interest

H.T. received lecture fees from Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Ltd., Daiichi Sankyo Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Bayer Pharmaceuticals Co., Ltd., and Pfizer Inc. H.T. received grants from Japan Tobacco Inc., Nippon Boehringer Ingelheim Co., Ltd., and Mitsubishi Tanabe Pharma Co., Ltd. H.T. received scholarship donations from MSD Co., Ltd., Daiichi Sankyo Co., Ltd., Mitsubishi Tanabe Pharma Co., Ltd., Teijin Pharma Co., Ltd., and Nippon Boehringer Ingelheim Co., Ltd. All other authors have no conflicts 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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kang, MJ., Sawatari, H., Chishaki, H. et al. Elaborate evaluation of serial changes in electrocardiograms of atrial septal defects after transcatheter closure for a better understanding of the recovery process. Heart Vessels 35, 1594–1604 (2020). https://doi.org/10.1007/s00380-020-01632-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-020-01632-x

Keywords

Search

Navigation