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Updated: Jun 16, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Atrioventricular block after transcatheter ASD closure using the Amplatzer septal occluder: risk factors and
Shada J Al-Anani1, Howard Weber, Ziyad M Hijazi
1Department of Pediatrics and Medicine, Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Illinois 60612, USA.
Insights
Transcatheter device closure for atrial septal defects (ASD) is effective but can rarely cause atrioventricular block. Surgical removal of the device resolved this rare complication in two patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter device closure is a safe and effective alternative to surgical repair for atrial septal defects (ASD).
- While generally associated with lower complication rates than surgery, arrhythmias can occur as infrequent complications of device closure.
- Complete heart block is a rare but serious complication of both surgical and transcatheter closure of ASDs.
Observation:
- Two patients developed atrioventricular (AV) block within 48 hours of uncomplicated transcatheter ASD closure using the Amplatzer septal occluder (ASO) device.
- Medical management with high-dose steroids and non-steroidal anti-inflammatory agents proved inadequate in both cases.
- Both patients required surgical removal of the ASO device to resolve the AV block.
Findings:
- Complete resolution of atrioventricular conduction abnormalities was achieved after surgical device removal.
- The study highlights AV block as a rare but significant complication following transcatheter ASD device closure.
- Prompt surgical intervention may be necessary for refractory AV block post-device closure.
Implications:
- This case series suggests that surgical removal of the ASO device can be a successful treatment for AV block after transcatheter ASD closure.
- Understanding the etiology and risk factors for AV block is crucial for preventing and managing this complication.
- Further research is warranted to establish optimal management strategies for AV block following transcatheter ASD device closure.
Abstract:
Transcatheter device closure of atrial septal defects is now considered an alternative option to open heart surgery with good short-term and long-term results (Du et al., J Am Coll Cardiol 2002;39:1836-1844, Chessa et al., J Am Coll Cardiol 2002;39:1061-1065); in comparison with surgical closure, the complication rate is lower (Du et al., J Am Coll Cardiol 2002;39:1836-1844). Arrhythmias are known infrequent complications of device closure. However, complete heart block is a rare complication of both treatment modalities (Chessa et al., J Am Coll Cardiol 2002;39:1061-1065). We report two patients who developed atrioventricular (AV) block within 48 hr after uncomplicated device closure of ASD using the Amplatzer septal occluder (ASO) device. Despite trials of high dose steroids and non-steroidal anti-inflammatory agents in both patients, the response was inadequate and by the end of the first week, both patients were ultimately sent for surgical removal of their devices with complete resolution of their atrioventricular conduction abnormalities. We discuss the possible etiology and risk factors of AV block and propose recommendations for management of such a complication.
