Ortega Michel Cabrera, Ramos Dunia Bárbara Benítez, Novoa Juan Carlos Ramiro, Suarez Francisco Javier Ozores, Ramírez Francisco Díaz, González Mabel Domínguez
Section of Arrhythmia and Cardiac Pacing, Cardiocentro Pediátrico William Soler, San Francisco e/ 100 y Perla, 10800, Boyeros, La Habana, Cuba.
Department of Pediatric Cardiology, Cardiocentro Pediátrico William Soler, 100 y Perla, Boyeros, Havana, Cuba.
Pediatr Cardiol. 2020 Jan;41(1):54-61. doi: 10.1007/s00246-019-02221-0. Epub 2019 Oct 31.
Atrial septal defect (ASD) is a condition that requires early intervention because of the consequences over the right-side heart. Chronic atrial stretching promotes atrial conduction delay and the imbalance of the conduction homogeneity, which lead to the propensity to atrial arrhythmias (AA). We aim to evaluate the impact of transcatheter closure of ASD on atrial vulnerability markers leading to late AA in young adults. We conducted a prospective, longitudinal study in one hundred patients (mean age 25.2 ± 5.4 years) who underwent transcatheter closure of ASD at Cardiocentro Pediátrico William Soler. P-wave maximum (P) and P-wave dispersion (P) were analyzed from 12-lead electrocardiogram. Left-side and right-side intraatrial and interatrial electromechanical delay (EMD) were measured with tissue Doppler imaging. Both electrocardiographic and echocardiographic analyses were performed during the study period. Compared to baseline, there was a significant reduction in P max (p ≤ 0.001) and P (p ≤ 0.001) after 3 months of procedure. All atrial electromechanical coupling parameters significantly reduced at 6 months of ASD closure and tend to remain at lower values till the last evaluation. Over 9.2 ± 1.6 years of follow-up, 15 subjects (15%) developed AA, of which intraatrial reentrant tachycardia (66.6%) became the main rhythm disturbance. Intra-right atrial EMD ≥ 16 ms (HR 4.08, 95% CI 1.15-14.56; p = 0.03) and P 45 ms (HR 1.66, 95% CI 1.06-2.59; p = 0.02) were identified as predictors of late AA. Transcatheter device closure of ASD in young adults promotes a significant reduction of electrocardiographic and echocardiographic markers of AA vulnerability, which persist during the long-term follow-up. Nevertheless, P and interatrial EMD were identified as independent risk factors of AA.
房间隔缺损（ASD）是一种因对右心产生的后果而需要早期干预的病症。慢性心房扩张会促进心房传导延迟以及传导均匀性失衡，进而导致心房颤动（AA）的倾向。我们旨在评估经导管封堵ASD对导致年轻成人晚期AA的心房易损性标志物的影响。我们对100例患者（平均年龄25.2±5.4岁）进行了一项前瞻性纵向研究，这些患者在威廉·索勒儿科心脏病中心接受了经导管封堵ASD治疗。从12导联心电图分析P波最大值（P）和P波离散度（P）。用组织多普勒成像测量左、右心房内及房间机电延迟（EMD）。在研究期间进行了心电图和超声心动图分析。与基线相比，术后3个月时P max（p≤0.001）和P（p≤0.001）显著降低。在ASD封堵6个月时，所有心房机电耦合参数均显著降低，并在最后一次评估前趋于保持在较低值。在9.2±1.6年的随访中，15名受试者（15%）发生了AA，其中房内折返性心动过速（66.6%）成为主要的节律紊乱。右心房内EMD≥16 ms（HR 4.08，95%CI 1.15 - 14.56；p = 0.03）和P≥45 ms（HR 1.66，95%CI 1.06 - 2.59；p = 0.02）被确定为晚期AA的预测因素。年轻成人经导管装置封堵ASD可显著降低AA易损性的心电图和超声心动图标志物，这些标志物在长期随访中持续存在。然而，P和房间EMD被确定为AA的独立危险因素。
