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Updated: Mar 16, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Atrioventricular block after ASD closure
Hiroko Asakai1, Sofia Weskamp2, Lucas Eastaugh2
1Department of Cardiology, Royal Children's Hospital, Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Pediatrics, University of Tokyo Hospital, Tokyo, Japan.
Insights
Late atrioventricular (AV) block after atrial septal defect (ASD) closure is rare. Pre-existing or post-procedure AV block is the main risk factor, particularly in device closure patients, necessitating long-term follow-up.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Secundum atrial septal defect (ASD) is a common congenital heart defect.
- Limited data exists on early and late atrioventricular (AV) block following ASD closure.
Purpose of the Study:
- To determine the incidence and risk factors of AV block associated with ASD closure.
Main Methods:
- Retrospective analysis of 378 patients undergoing ASD closure (device or surgical) between 1996-2010.
- Data collected included demographics, procedural details, and follow-up information.
Main Results:
- 14 patients (3.7%) experienced AV block (1 second-degree, 13 first-degree) at median 28-month follow-up.
- In the device group, larger indexed device size correlated with AV block (p=0.02).
- Pre- or post-procedure AV block was the only significant predictor of late AV block.
Conclusions:
- Late AV block post-ASD repair is uncommon and appears independent of closure technique.
- Pre-existing or post-procedure AV block is a key risk factor, especially with device closure.
- Long-term follow-up is recommended for patients with AV block history.
Objective:
Secundum atrial septal defect (ASD) is a common congenital heart defect. There is limited data on both early and late atrioventricular (AV) block post ASD closure. The aim of this study was to determine the incidence and risk factors of AV block associated with ASD closure.
Methods:
A retrospective analysis of all patients who underwent ASD closure either with a device or surgical method at the Royal Children's Hospital Melbourne between 1996 and 2010 was performed. Baseline demographics, procedural details and follow-up data were collected from medical records.
Results:
A total of 378 patients were identified; 242 in the device group and 136 in the surgical group. Fourteen patients (3.7%) had AV block (1 with second degree and 13 with first degree) at a median follow-up of 28 months; 11/242 (4.5%) in the device group and 3/135 (2.2%) in the surgical group (p=0.39). Six patients had new-onset AV block after ASD closure. In the device subgroup, patients with AV block at follow-up had a larger indexed device size compared with those without (22 (15-31) vs 18(7-38), p=0.02). Multivariate analysis revealed the presence of AV block either pre procedure or post procedure to be the only variables associated with late AV block.
Conclusions:
Late AV block in patients with repaired ASD is rare and most likely independent of the technique used. In the device subgroup, the only risk factor identified to be associated with late AV block was the presence of either preprocedural or postprocedural AV block, so long-term follow-up for these patients should be provided.
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