Division of Cardiology, and Heart Education And Research Training (HEART) Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Int J Cardiol. 2013 Sep 20;168(1):467-71. doi: 10.1016/j.ijcard.2012.09.119. Epub 2012 Oct 9.
Late-onset atrial arrhythmia after successful closure of atrial septal defect (ASD) is not uncommon. Right atrial (RA) enlargement and increased electrocardiographic P-wave dispersion (Pd) independently predict the development of atrial arrhythmia. Data on the degree of right atrial (RA) geometrical and electrical remodeling following device closure of ASD are limited.
Echocardiography and electrocardiography (ECG) were performed in 58 consecutive patients (47 ± 17 years) before and at 3 months after ASD closure. Persistent RA enlargement was defined as RA volume index (RAVI) ≥ 21 ml/m(2) at 3 months. Pd was calculated as the difference between maximal and minimal P-wave durations in 12-lead ECG.
RA size reduced (RAVI: 50 ± 28 vs. 26 ± 16 ml/m(2), p<0.001) and Pd on ECG decreased (53 ± 17 vs. 49 ± 20 ms, p<0.05) significantly at 3 months when compared to baseline. However, persistent RA enlargement remained evident in 31 patients (53%). As a group, they were older with higher pulmonary arterial systolic pressure, larger Qp/Qs, longer maximal P-wave duration and Pd than those with normalized RA. Pd reduction only occurred in patients with normalized RA size. The 3-month Pd (hazard ratio: 1.033, p<0.001) predicted the presence of incomplete RA geometrical remodeling. ROC curve revealed that Pd ≥ 45 ms at 3 months was 77% sensitive and 86% specific in revealing residual RA enlargement.
Both atrial geometrical and electrical reverse remodeling were evident at 3 months following ASD closure. However, only half of the included patients had normalization of RA size which could be revealed by a simple ECG surrogate of intra-atrial conduction disturbance.
成功封堵房间隔缺损（ASD）后出现的迟发性房性心律失常并不少见。右心房（RA）扩大和心电图 P 波离散度（Pd）增加均可独立预测房性心律失常的发生。关于 ASD 封堵后右心房（RA）几何和电重构程度的数据有限。
对 58 例连续患者（47±17 岁）在 ASD 封堵前和封堵后 3 个月进行超声心动图和心电图（ECG）检查。持续性 RA 扩大定义为 3 个月时 RA 容积指数（RAVI）≥21ml/m2。Pd 计算为 12 导联心电图中最大和最小 P 波时限的差值。
与基线相比，3 个月时 RA 大小减小（RAVI：50±28 与 26±16ml/m2，p<0.001），ECG 上的 Pd 降低（53±17 与 49±20ms，p<0.05）。然而，仍有 31 例患者（53%）存在持续性 RA 扩大。作为一个整体，他们年龄较大，肺动脉收缩压较高，Qp/Qs 较大，最大 P 波时限和 Pd 较长，RA 大小正常。只有在 RA 大小正常的患者中，Pd 才会降低。3 个月时的 Pd（危险比：1.033，p<0.001）预测了不完全 RA 几何重构的存在。ROC 曲线显示，3 个月时 Pd≥45ms 在揭示残余 RA 扩大方面的敏感性为 77%，特异性为 86%。
ASD 封堵后 3 个月时，心房几何和电重构均明显。然而，只有一半的患者 RA 大小正常，这可以通过简单的心电图来显示房内传导障碍的替代指标来揭示。
