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Erschienen in: Heart and Vessels 11/2020

29.05.2020 | Original Article

Elaborate evaluation of serial changes in electrocardiograms of atrial septal defects after transcatheter closure for a better understanding of the recovery process

verfasst von: Min-Jeong Kang, Hiroyuki Sawatari, Hiroaki Chishaki, Ryoji Shinbara, Keiko Yamasaki, Tasuku Sato, Kanae Fujita, Ichiro Sakamoto, Ken-ichi Hiasa, Ayako Ishikita, Shintaro Umemoto, Mari Nishizaka, Hiroyuki Tsutsui, Chizuko A. Kamiya, Koichiro Niwa, Akiko Chishaki

Erschienen in: Heart and Vessels | Ausgabe 11/2020

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Abstract

Serial changes of electrocardiograms (ECG) could be used to assess their clinical features in atrial septal defects (ASD) after transcatheter closure together with other clinical parameters. We retrospectively studied 100 ASD patients who underwent transcatheter closure. Complications of persistent atrial fibrillation occurred in five ASD patients, and they were excluded. We divided the other 95 patients according to PQ intervals before closure (normal: < 200 ms, n = 51; prolonged: ≥ 200 ms, n = 44) to evaluate their clinical characteristics and parameters such as echocardiography, chest X-rays, and brain natriuretic protein (BNP) levels. Individuals in the prolonged PQ group were significantly older, had higher incidences of paroxysmal atrial fibrillation (PAF) and heart failure (HF) treated with more β-blockers and diuretics, and with a higher tendency of NYHA functional classification and BNP levels than the normal PQ group. The prolonged PQ group also had a significantly higher incidence of complete right bundle branch block, wider QRS intervals, and larger cardiothoracic ratios in chest X-rays accompanied by larger right atrial-areas and larger left atrial dimensions in echocardiograms. Furthermore, the prolonged PQ intervals with less PQ interval shortening after transcatheter closure revealed that the patients were the oldest at the time of closures and showed less structural normalization of the right heart and left atrium after ASD closure. PAF and HF also occurred more frequently in this subgroup. These results suggested that the ASD patients with prolonged PQ intervals with less PQ shortening were accompanied by more advanced clinical conditions. Together with other clinical parameters, detailed analyses of ECG and their changes after closure could elucidate the clinical characteristics and status of ASD patients with transcatheter closure and were useful for predicting structural normalization after transcatheter closure.
Literatur
1.
Zurück zum Zitat Hoffman JI, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39:1890–1900CrossRef Hoffman JI, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39:1890–1900CrossRef
2.
Zurück zum Zitat Botto LD, Correa A, Erickson JD (2001) Racial and temporal variations in the prevalence of heart defects. Pediatrics 107:E32CrossRef Botto LD, Correa A, Erickson JD (2001) Racial and temporal variations in the prevalence of heart defects. Pediatrics 107:E32CrossRef
3.
Zurück zum Zitat Hannoush H, Tamim H, Younes H, Arnaout S, Gharzeddine W, Dakik H, Obeid M, Bitar FF (2004) Patterns of congenital heart disease in unoperated adults: a 20-year experience in a developing country. Clin Cardiol 27:236–240CrossRef Hannoush H, Tamim H, Younes H, Arnaout S, Gharzeddine W, Dakik H, Obeid M, Bitar FF (2004) Patterns of congenital heart disease in unoperated adults: a 20-year experience in a developing country. Clin Cardiol 27:236–240CrossRef
4.
Zurück zum Zitat van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, Roos-Hesselink JW (2011) Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 58:2241–2247CrossRef van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, Roos-Hesselink JW (2011) Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 58:2241–2247CrossRef
5.
Zurück zum Zitat Attie F, Rosas M, Granados N, Zabal C, Buendia A, Calderon J (2001) Surgical treatment for secundum atrial septal defects in patients %3e40 years old. A randomized clinical trial. J Am Coll Cardiol 38:2035–2042CrossRef Attie F, Rosas M, Granados N, Zabal C, Buendia A, Calderon J (2001) Surgical treatment for secundum atrial septal defects in patients %3e40 years old. A randomized clinical trial. J Am Coll Cardiol 38:2035–2042CrossRef
6.
Zurück zum Zitat Brochu MC, Baril JF, Dore A, Juneau M, De Guise P, Mercier LA (2002) Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Circulation 106:1821–1826CrossRef Brochu MC, Baril JF, Dore A, Juneau M, De Guise P, Mercier LA (2002) Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Circulation 106:1821–1826CrossRef
7.
Zurück zum Zitat Nyboe C, Karunanithi Z, Nielsen-Kudsk JE, Hjortdal VE (2018) Long-term mortality in patients with atrial septal defect: a nationwide cohort-study. Eur Heart J 39:993–998CrossRef Nyboe C, Karunanithi Z, Nielsen-Kudsk JE, Hjortdal VE (2018) Long-term mortality in patients with atrial septal defect: a nationwide cohort-study. Eur Heart J 39:993–998CrossRef
8.
Zurück zum Zitat Roos-Hesselink JW, Meijboom FJ, Spitaels SE, van Domburg R, van Rijen EH, Utens EM, Bogers AJ, Simoons ML (2003) Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. A prospective follow-up study of 21–33 years. Eur Heart J 24:190–197CrossRef Roos-Hesselink JW, Meijboom FJ, Spitaels SE, van Domburg R, van Rijen EH, Utens EM, Bogers AJ, Simoons ML (2003) Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. A prospective follow-up study of 21–33 years. Eur Heart J 24:190–197CrossRef
9.
Zurück zum Zitat Oster M, Bhatt AB, Zaragoza-Macias E, Dendukuri N, Marelli A (2019) Interventional therapy versus medical therapy for secundum atrial septal defect: a systematic review (part 2) for the 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. J Am Coll Cardiol 73:1579–1595CrossRef Oster M, Bhatt AB, Zaragoza-Macias E, Dendukuri N, Marelli A (2019) Interventional therapy versus medical therapy for secundum atrial septal defect: a systematic review (part 2) for the 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. J Am Coll Cardiol 73:1579–1595CrossRef
10.
Zurück zum Zitat Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF (2019) 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. Circulation 139:e698–e800PubMed Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF (2019) 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. Circulation 139:e698–e800PubMed
11.
Zurück zum Zitat Humenberger M, Rosenhek R, Gabriel H, Rader F, Heger M, Klaar U, Binder T, Probst P, Heinze G, Maurer G, Baumgartner H (2011) Benefit of atrial septal defect closure in adults: impact of age. Eur Heart J 32:553–560CrossRef Humenberger M, Rosenhek R, Gabriel H, Rader F, Heger M, Klaar U, Binder T, Probst P, Heinze G, Maurer G, Baumgartner H (2011) Benefit of atrial septal defect closure in adults: impact of age. Eur Heart J 32:553–560CrossRef
12.
Zurück zum Zitat Varma C, Benson LN, Silversides C, Yip J, Warr MR, Webb G, Siu SC, McLaughlin PR (2004) Outcomes and alternative techniques for device closure of the large secundum atrial septal defect. Catheter Cardiovasc Interv 61:131–139CrossRef Varma C, Benson LN, Silversides C, Yip J, Warr MR, Webb G, Siu SC, McLaughlin PR (2004) Outcomes and alternative techniques for device closure of the large secundum atrial septal defect. Catheter Cardiovasc Interv 61:131–139CrossRef
13.
Zurück zum Zitat Takaya Y, Akagi T, Kijima Y, Nakagawa K, Sano S, Ito H (2015) Long-term outcome after transcatheter closure of atrial septal defect in older patients: impact of age at procedure. JACC Cardiovasc Interv 8:600–606CrossRef Takaya Y, Akagi T, Kijima Y, Nakagawa K, Sano S, Ito H (2015) Long-term outcome after transcatheter closure of atrial septal defect in older patients: impact of age at procedure. JACC Cardiovasc Interv 8:600–606CrossRef
14.
Zurück zum Zitat Fang F, Luo XX, Lin QS, Kwong JS, Zhang YC, Jiang X, Yu CM, Lam YY (2013) Characterization of mid-term atrial geometrical and electrical remodeling following device closure of atrial septal defects in adults. Int J Cardiol 168:467–471CrossRef Fang F, Luo XX, Lin QS, Kwong JS, Zhang YC, Jiang X, Yu CM, Lam YY (2013) Characterization of mid-term atrial geometrical and electrical remodeling following device closure of atrial septal defects in adults. Int J Cardiol 168:467–471CrossRef
15.
Zurück zum Zitat Kamphuis VP, Nassif M, Man SC, Swenne CA, Kors JA, Vink AS, Ten Harkel ADJ, Maan AC, Mulder BJM, de Winter RJ, Blom NA (2019) Electrical remodeling after percutaneous atrial septal defect closure in pediatric and adult patients. Int J Cardiol 285:32–39CrossRef Kamphuis VP, Nassif M, Man SC, Swenne CA, Kors JA, Vink AS, Ten Harkel ADJ, Maan AC, Mulder BJM, de Winter RJ, Blom NA (2019) Electrical remodeling after percutaneous atrial septal defect closure in pediatric and adult patients. Int J Cardiol 285:32–39CrossRef
16.
Zurück zum Zitat Muta H, Akagi T, Egami K, Furui J, Sugahara Y, Ishii M, Matsuishi T (2003) Incidence and clinical features of asymptomatic atrial septal defect in school children diagnosed by heart disease screening. Circ J 67:112–115CrossRef Muta H, Akagi T, Egami K, Furui J, Sugahara Y, Ishii M, Matsuishi T (2003) Incidence and clinical features of asymptomatic atrial septal defect in school children diagnosed by heart disease screening. Circ J 67:112–115CrossRef
17.
Zurück zum Zitat Kaya MG, Baykan A, Dogan A, Inanc T, Gunebakmaz O, Dogdu O, Uzum K, Eryol NK, Narin N (2010) Intermediate-term effects of transcatheter secundum atrial septal defect closure on cardiac remodeling in children and adults. Pediatr Cardiol 31:474–482CrossRef Kaya MG, Baykan A, Dogan A, Inanc T, Gunebakmaz O, Dogdu O, Uzum K, Eryol NK, Narin N (2010) Intermediate-term effects of transcatheter secundum atrial septal defect closure on cardiac remodeling in children and adults. Pediatr Cardiol 31:474–482CrossRef
18.
Zurück zum Zitat Veldtman GR, Razack V, Siu S, El-Hajj H, Walker F, Webb GD, Benson LN, McLaughlin PR (2001) Right ventricular form and function after percutaneous atrial septal defect device closure. J Am Coll Cardiol 37:2108–2113CrossRef Veldtman GR, Razack V, Siu S, El-Hajj H, Walker F, Webb GD, Benson LN, McLaughlin PR (2001) Right ventricular form and function after percutaneous atrial septal defect device closure. J Am Coll Cardiol 37:2108–2113CrossRef
19.
Zurück zum Zitat Khairy P, Marelli AJ (2007) Clinical use of electrocardiography in adults with congenital heart disease. Circulation 116:2734–2746CrossRef Khairy P, Marelli AJ (2007) Clinical use of electrocardiography in adults with congenital heart disease. Circulation 116:2734–2746CrossRef
20.
Zurück zum Zitat Di Bernardo S, Berger F, Fasnacht M, Bauersfeld U (2005) Impact of right ventricular size on ECG after percutaneous closure of atrial septal defect with Amplatzer Septal Occluder. Swiss Med Wkly 135:647–651PubMed Di Bernardo S, Berger F, Fasnacht M, Bauersfeld U (2005) Impact of right ventricular size on ECG after percutaneous closure of atrial septal defect with Amplatzer Septal Occluder. Swiss Med Wkly 135:647–651PubMed
21.
Zurück zum Zitat Thilen M, Christersson C, Dellborg M, Mattsson E, Trzebiatowska-Krzynska A, Thilen U (2016) Catheter closure of atrial septal defect in the elderly (%3e/=65years). A worthwhile procedure. Int J Cardiol 218:25–30CrossRef Thilen M, Christersson C, Dellborg M, Mattsson E, Trzebiatowska-Krzynska A, Thilen U (2016) Catheter closure of atrial septal defect in the elderly (%3e/=65years). A worthwhile procedure. Int J Cardiol 218:25–30CrossRef
22.
Zurück zum Zitat Komar M, Przewlocki T, Olszowska M, Sobien B, Stepniewski J, Podolec J, Mleczko S, Tomkiewicz-Pajak L, Zmudka K, Podolec P (2014) Conduction abnormality and arrhythmia after transcatheter closure of atrial septal defect. Circ J 78:2415–2421CrossRef Komar M, Przewlocki T, Olszowska M, Sobien B, Stepniewski J, Podolec J, Mleczko S, Tomkiewicz-Pajak L, Zmudka K, Podolec P (2014) Conduction abnormality and arrhythmia after transcatheter closure of atrial septal defect. Circ J 78:2415–2421CrossRef
23.
Zurück zum Zitat Bayar N, Arslan S, Koklu E, Cagirci G, Cay S, Erkal Z, Ayoglu RU, Kucukseymen S (2015) The importance of electrocardiographic findings in the diagnosis of atrial septal defect. Kardiol Pol 73:331–336CrossRef Bayar N, Arslan S, Koklu E, Cagirci G, Cay S, Erkal Z, Ayoglu RU, Kucukseymen S (2015) The importance of electrocardiographic findings in the diagnosis of atrial septal defect. Kardiol Pol 73:331–336CrossRef
24.
Zurück zum Zitat Schiller O, Greene EA, Moak JP, Gierdalski M, Berul CI (2013) The poor performance of RSR' pattern on electrocardiogram lead V1 for detection of secundum atrial septal defects in children. J Pediatr 162:308–312CrossRef Schiller O, Greene EA, Moak JP, Gierdalski M, Berul CI (2013) The poor performance of RSR' pattern on electrocardiogram lead V1 for detection of secundum atrial septal defects in children. J Pediatr 162:308–312CrossRef
25.
Zurück zum Zitat Mostafa S, Abdelhakim A, Aboelazm T, Arafa O, Elemam A (2017) Effect of transcatheter closure of secundum atrial septal defect on cardiac electric remodeling. Int J Heart Rhythm 2:40–48CrossRef Mostafa S, Abdelhakim A, Aboelazm T, Arafa O, Elemam A (2017) Effect of transcatheter closure of secundum atrial septal defect on cardiac electric remodeling. Int J Heart Rhythm 2:40–48CrossRef
26.
Zurück zum Zitat Gatzoulis MA, Freeman MA, Siu SC, Webb GD, Harris L (1999) Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 340:839–846CrossRef Gatzoulis MA, Freeman MA, Siu SC, Webb GD, Harris L (1999) Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 340:839–846CrossRef
27.
Zurück zum Zitat Akagi T (2015) Current concept of transcatheter closure of atrial septal defect in adults. J Cardiol 65:17–25CrossRef Akagi T (2015) Current concept of transcatheter closure of atrial septal defect in adults. J Cardiol 65:17–25CrossRef
Metadaten
Titel
Elaborate evaluation of serial changes in electrocardiograms of atrial septal defects after transcatheter closure for a better understanding of the recovery process
verfasst von
Min-Jeong Kang
Hiroyuki Sawatari
Hiroaki Chishaki
Ryoji Shinbara
Keiko Yamasaki
Tasuku Sato
Kanae Fujita
Ichiro Sakamoto
Ken-ichi Hiasa
Ayako Ishikita
Shintaro Umemoto
Mari Nishizaka
Hiroyuki Tsutsui
Chizuko A. Kamiya
Koichiro Niwa
Akiko Chishaki
Publikationsdatum
29.05.2020
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 11/2020
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-020-01632-x

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