Grignani Robert Teodoro, Tolentino Kim Martin, Rajgor Dimple Dayaram, Quek Swee Chye
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Pediatr Cardiol. 2015 Jun;36(5):1050-6. doi: 10.1007/s00246-015-1119-3. Epub 2015 Jan 28.
Transcatheter device closure of the secundum atrial septal defect (ASD) in children prevents atrial arrhythmias in older age. However, the benefits of favourable atrial electrocardiographic markers in these children remain elusive. We aimed to review the electrocardiographic markers of atrial activity in a longitudinal fashion. We retrospectively reviewed longitudinal data of all children who underwent transcatheter device closure at the National University Hospital between 2004 and 2013. The inclusion criteria included the presence of a secundum-type ASD with left to right shunt and evidence of increased right ventricular volume load (Q p/Q s ratio >1.5 and/or right ventricular dilatation). A total of 25 patients with a mean follow-up of 44.7 ± 33.47 (7.3-117.4) months were included. P maximum and P dispersion decreased at 2 months, P amplitude at 1 week and remained so until last follow-up. A positive trend was seen with a correlation coefficient of +0.12 for P maximum, +0.08 for P dispersion and 0.34 for P amplitude. There was a higher baseline P amplitude and P dispersion in patients who were older than 10 years and a non-significant trend to support an increase in both P maximum (71.0 ± 8.8 vs. 73.2 ± 12.7), P dispersion (17.0 ± 6.5 vs. 22.0 ± 11.3) and P amplitude (0.88 ± 0.25 vs. 1.02 ± 0.23) in patients with an ASD more than 15 mm compared with an ASD <15 mm. There is reduction in both P maximum and P dispersion as early as 2 months, which persisted on follow-up. Earlier closure may result in more favourable electrocardiographic results.
经导管装置闭合儿童继发孔型房间隔缺损（ASD）可预防老年时的房性心律失常。然而，这些儿童中有利的心房心电图标志物的益处仍不明确。我们旨在纵向回顾心房活动的心电图标志物。我们回顾性分析了2004年至2013年期间在国立大学医院接受经导管装置闭合术的所有儿童的纵向数据。纳入标准包括存在继发孔型ASD且有左向右分流以及右心室容量负荷增加的证据（Q p/Q s比值>1.5和/或右心室扩张）。共纳入25例患者，平均随访44.7±33.47（7.3 - 117.4）个月。P波最大时限和P波离散度在2个月时降低，P波振幅在1周时降低，并一直持续到最后一次随访。P波最大时限的相关系数为+0.12，P波离散度为+0.08，P波振幅为0.34，呈正趋势。10岁以上患者的基线P波振幅和P波离散度较高，与ASD<15 mm的患者相比，ASD大于15 mm的患者中P波最大时限（71.0±8.8 vs. 73.2±12.7）、P波离散度（17.0±6.5 vs. 22.0±11.3）和P波振幅（0.88±0.25 vs. 1.02±0.23）均有非显著性增加趋势。P波最大时限和P波离散度早在2个月时就降低，并在随访中持续存在。早期闭合可能会带来更有利的心电图结果。
