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Preoperative secundum atrial septal defect with coexisting sinus node and atrioventricular node dysfunction

E B Clark, J D Kugler

    Circulation
    |May 1, 1982
    PubMed
    Summary
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    Sinus node and atrioventricular node dysfunction were common in patients with secundum atrial septal defect before surgery. These findings suggest pre-existing electrical abnormalities, not solely surgical damage, contribute to heart rhythm issues.

    Area of Science:

    • Cardiology
    • Electrophysiology
    • Pediatric Heart Surgery

    Background:

    • Sinus node dysfunction after atrial septal defect repair is often attributed to surgical impact.
    • Understanding pre-operative cardiac electrical function is crucial for managing post-operative outcomes.

    Purpose of the Study:

    • To investigate the prevalence and characteristics of sinus node and atrioventricular node dysfunction in patients with secundum atrial septal defect prior to surgical repair.
    • To differentiate between pre-existing electrical abnormalities and surgically induced dysfunction.

    Main Methods:

    • Utilized noninvasive 34-hour electrocardiographic monitoring and a 13-lead ECG.
    • Employed intracardiac electrophysiologic techniques including corrected sinus node recovery time, sinoatrial conduction time, His bundle intervals (AH, HV), and atrioventricular nodal function tests (Wenckebach, refractory period).

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    Main Results:

    • Electrocardiogram revealed ectopic atrial rhythm in 2 of 15 patients.
    • Intracardiac electrophysiology identified abnormal corrected sinus node recovery time in 10 patients.
    • Five patients exhibited atrioventricular node dysfunction, indicated by prolonged AH intervals or abnormal Wenckebach pacing rates.

    Conclusions:

    • Sinus node dysfunction and atrioventricular node dysfunction are present in a significant proportion of patients with secundum atrial septal defect before surgical intervention.
    • These pre-existing electrical abnormalities may play a role in post-operative arrhythmias, challenging the sole attribution to surgical damage.