Electrical remodeling after percutaneous atrial septal defect closure in pediatric and adult patients. (15th June 2019)

• Record Type: Journal Article
• Authors: Kamphuis, Vivian P.; Nassif, Martina; Man, Sum-Che; Swenne, Cees A.; Kors, Jan A.; Vink, A. Suzanne; ten Harkel, Arend D.J.; Maan, Arie C.; Mulder, Barbara J.M.; de Winter, Rob J.; Blom, Nico A.
• Is Part Of: International journal of cardiology. Volume 285(2019)
• Page Start: 32
• Page End: 39
• Publication Date: 2019-06-15
• Subjects: Atrial septal defect -- Electrocardiography -- Vectorcardiography -- Ventricular gradient -- QRS-T angle; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.02.020
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Several studies have reported changes in electrocardiographic variables after atrial septal defect (ASD) closure. However no temporal electro-and vectorcardiographic changes have been described from acute to long-term follow-up at different ages. We aimed to study electrical remodeling after percutaneous ASD closure in pediatric and adult patients. Methods: ECGs of 69 children and 75 adults (median age 6 [IQR 4–11] years and 45 [IQR 33–54] years, respectively) were retrospectively selected before percutaneous ASD closure and at acute (1–7 days), intermediate (4–14 weeks) and late (6–18 months) follow-up. Apart from electrocardiographic variables, spatial QRS-T angle and ventricular gradient (VG) were derived from mathematically-synthesized vectorcardiograms. Results: In both pediatric and adult patients, the heart rate decreased immediately post-closure, which persisted to late follow-up. The P-wave amplitude also decreased acutely post-closure, but remained unchanged at later follow-up. The PQ duration shortened immediately in children and at intermediate follow-up in adults. The QRS duration and QTc interval decreased at intermediate-term follow-up in both children and adults. In both groups the spatial QRS-T angle decreased at late follow-up. The VG magnitude increased at intermediate follow-up in children and at late follow-up in adults, after an initial decrease in children. Conclusion: In both pediatric and adult ASD patients, electrocardiographic changes mainly occurred directly after ASD closure except for shortening of QRS duration and QTc interval, which occurred at later follow-up. Adults also showed late changes in PQ duration. At 6-to-18 month post-closure, the spatial QRS-T angle decreased, reflecting increased electrocardiographic concordance. The initial acute decrease in VG in children, which was followed by a significant increase, may be the effect of action potential duration dynamics directly after percutaneous ASD closure. Highlights: ECG changes mainly occurred directly after ASD closure. The QRS-T angle decreased after ASD closure, reflecting increased ECG concordance. The ventricular gradient decreased after ASD closure, followed by an increase.