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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
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Electrocardiographic changes and arrhythmias following percutaneous atrial septal defect and patent foramen ovale

Jonathan N Johnson1, Michelle L Marquardt, Michael J Ackerman

  • 1Department of Pediatrics/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|May 13, 2011
PubMed

Insights

Percutaneous closure of atrial septal defects (ASD) and patent foramen ovale (PFO) has a low risk of significant arrhythmias. Device placement may affect intra-atrial conduction, with new-onset heart block linked to increased atrial tachyarrhythmias.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Percutaneous device closure for ASD and PFO is a common procedure.
  • Potential conduction and rhythm anomalies post-device placement have been documented.

Purpose of the Study:

  • To compare pre- and post-procedure electrocardiograms (ECGs) in patients undergoing percutaneous closure of ASD or PFO.
  • To assess the incidence of arrhythmias and changes in atrial conduction markers following device placement.

Main Methods:

  • Retrospective review of records for patients who underwent percutaneous closure of ASD or PFO between 1999 and 2008.
  • Comparison of pre-procedure ECGs and Holter studies with short-term (<2 months) and intermediate (>2 months) follow-up ECGs or Holters.

Main Results:

  • In 610 patients, 5.2% experienced arrhythmias within 4 months of device placement, including atrial tachyarrhythmias and heart block.
  • A significant increase in P-wave duration was observed on intermediate follow-up compared to early follow-up (P < 0.001).
  • New-onset first-degree AV block was associated with an increased risk of post-procedure atrial tachyarrhythmias (P < 0.0001).

Conclusions:

  • Percutaneous device closure of ASD/PFO carries a low risk of clinically significant post-procedure arrhythmias.
  • Clinically significant heart block occurred in only 0.3% of patients.
  • Device closure appears to influence intra-atrial conduction, indicated by changes in ECG markers.
Abstract

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