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Updated: Jan 11, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Atrioventricular block after transcatheter atrial septal defect closure: Comprehensive short-term to long-term
Md PhD Shuenn-Nan Chiu1, Ming-Tai Lin1, Chun-An Chen1
1Department of Pediatric, National Taiwan University Hospital, Taipei, Taiwan.
Background:
Transcatheter closure is the preferred treatment for secundum atrial septal defect (ASD), with atrioventricular block (AVB) being a rare but serious complication.
Objective:
This study comprehensively investigates AVB incidence, risk factors, and outcomes after transcatheter ASD closure, uniquely offering detailed long-term follow-up.
Methods:
We retrospectively analyzed 1954 patients (median age 16 years [1-86]; 31.1% male) who underwent transcatheter ASD closure at 3 tertiary centers between 1999 and 2024. Patients with complex congenital heart disease or preexisting high-degree AVB were excluded. Clinical, procedural, and follow-up data were analyzed.
Results:
AVB occurred in 1.5% of patients, with complete AVB (CAVB) in 0.81% (median age 5.5 years [1.9-15]; male 46.7%). Younger age, lower body weight, and larger device size were identified as risk factors for CAVB. A device size-to-square root (body weight) ratio of >5.28 had positive and negative predictive values of 7% and 99.8%, respectively, for CAVB in patients younger than 10 years in the study cohort. Management strategies (corticosteroid therapy, device downsizing, surgical removal) showed varied efficacy (0%-66.6% response for CAVB), but none consistently reversed CAVB. 4 patients (0.2%) required a permanent pacemaker or had persistent CAVB at discharge. After a mean follow-up of 8.1 ± 6.3 years, no new-onset late high-degree AVB was observed.
Conclusion:
AVB after transcatheter ASD closure is rare, with most cases resolving. Late AVB is even rarer. Given the limited efficacy of interventions for established CAVB, careful device size selection, particularly in younger, low-weight patients, is essential to minimize risks and improve outcomes.
