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Updated: May 6, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Risk factors and prognosis of atrioventricular block after atrial septum defect closure using the Amplatzer device
1Division of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Szechuan, China.
Insights
Atrial septum defect closure with Amplatzer devices can cause atrioventricular block (AVB). Younger age, larger defects, and specific device ratios are risk factors. Milder AVB indicates a better prognosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Complications associated with the Amplatzer septal occluder (ASO) are known.
- Atrioventricular block (AVB) following atrial septum defect (ASD) closure using the ASO device is under-recognized.
- Understanding AVB risk factors and prognosis is crucial for patient safety.
Purpose of the Study:
- To analyze risk factors for AVB after catheter-based ASD closure with ASO.
- To evaluate prognostic indicators for AVB post-procedure.
- To identify strategies for reducing adverse events related to AVB.
Main Methods:
- Retrospective analysis of 706 ASD patients undergoing ASO closure.
- Investigated relationships between AVB and patient/device factors: age, ASD size (D(d)), occluder diameter (D(o)), septum diameter (D(s)), D(o)/D(d), and D(o)/D(s) ratios.
- Statistical analysis included Kolmogorov-Smirnov and Wilcoxon rank sum tests (p<0.05 significant).
Main Results:
- AVB incidence was 0.85% (6 out of 706 patients).
- Risk factors for AVB included younger age, larger ASD size, larger device size, and a D(o)/D(s) ratio ≥0.45.
- Milder AVB correlated with better prognosis; AVB III° and unchanged ECG within 3 days were poor prognostic signs.
Conclusions:
- AVB is a potential complication of ASO-induced ASD closure requiring increased clinical attention.
- Key risk factors identified are younger patient age, larger ASDs, larger devices, and a D(o)/D(s) ratio of 0.45 or higher.
- Timely device retrieval should be considered for patients with poor prognostic indicators to improve outcomes.
Abstract:
Amplatzer septal occluder (ASO)-induced complications have been observed. However, little attention is paid to the atrioventricular block (AVB) induced by atrial septum defect (ASD) closure using the Amplatzer device. This study aimed to analyze the risk factors and prognosis of AVB after catheter closure and to reduce the incidence of adverse events. In this study, 706 ASD patients who received closure in our division were investigated retrospectively for the relationship between AVB and factors such as age, size of the ASD (D(d)), diameter of the occluder (D(o)), diameter of the septum (D(s)), D(o)/D(d) ratio, and D(o)/D(s) ratio. Data distribution was evaluated with the Kolmogorov-Smirnov normality test. The Wilcoxon rank sum test was used to compare non-normal distribution data. A p value lower than 0.05 was considered significant. Of the 706 patients, six had experienced the development of AVB, giving an incidence of 0.85%. The risk factors included younger age, larger size of the ASD, larger size of the device, and the D(o)/D(s) ratio (≥0.45). The milder AVB is, the better the prognosis. An AVB of III° and an unchanged electrocardiogram (ECG) within 3 days after the procedure are poor prognostic indicators. More attention should be paid to AVB induced by ASD closure. Younger age, size of the ASD, size of the device, and a D(o)/D(s) ratio of 0.45 or higher are the risk factors associated with AVB after closure. A timely retrieval of the device should be considered for a good prognosis.
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