Department of Pediatric Cardiology, Dr. Behcet Uz Children's Hospital, Izmir, Türkiye.
Department of Pediatric Cardiovascular Surgery, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye.
Turk Kardiyol Dern Ars. 2023 Jan;51(1):50-55. doi: 10.5543/tkda.2022.98384.
Atrial septal defect (ASD) accounts for 6-10% of all congenital heart disorders. Secundum ASD closure can be performed surgically or percutaneously. We aimed to identify the various arrhythmias that occur before, during, and after the procedure and evaluate their management.
The study included a total of 427 patients aged 0-18 years who underwent transcatheter or surgical closure of isolated secundum ASD between January 2008 and January 2020. Postoperative electrocardiogram (ECG) traces, intraoperative arrhythmias, and treatments were recorded for both groups. Echocardiography and ECG were evaluated at postoperative 1 week, 1, 3, and 6 months, and annually thereafter.
After transcatheter closure, follow-up basal ECG showed incomplete right bundle branch block pattern in 21 patients and sinus rhythm in 229 patients. After surgical closure, incomplete right bundle branch block pattern was detected in 23 patients, complete right bundle branch block in 3 patients, and complete AV-block (Atrioventricular Block) pattern in 1 patient. The other 150 patients showed sinus rhythm. At least one postoperative follow-up Holter ECG record could be obtained for 104 patients in the transcatheter group and 96 patients in the surgical group. Of 104 patients who underwent transcatheter closure, 97 (93.3%) had normal Holter ECG findings and 7 (6.7%) had arrhythmia. Of the 96 patients who underwent surgical closure, 85 (88.5%) had normal Holter ECG traces and 11 (11.5%) had arrhythmia. There was no statistically significant difference in the frequency of arrhythmia (P = 0.164).
The higher frequency of arrhythmia in adult studies compared to the pediatric age group once again demonstrates the importance of early diagnosis and treatment of ASD in childhood. The similar incidence of arrhythmia in both groups supports the safety and effectiveness of both closure methods in eligible patients.
房间隔缺损（ASD）占所有先天性心脏病的 6-10%。继发孔 ASD 可通过手术或经皮进行闭合。我们旨在确定在手术前后发生的各种心律失常，并评估其管理方法。
本研究共纳入 2008 年 1 月至 2020 年 1 月期间接受经导管或手术闭合孤立性继发孔 ASD 的 427 例 0-18 岁患者。记录两组患者的术后心电图（ECG）轨迹、术中心律失常和治疗情况。术后 1 周、1、3 和 6 个月以及此后每年进行超声心动图和心电图检查。
经导管闭合后，21 例患者的基础心电图显示不完全右束支传导阻滞模式，229 例患者显示窦性心律。手术后，23 例患者出现不完全右束支传导阻滞模式，3 例患者出现完全右束支传导阻滞模式，1 例患者出现完全房室传导阻滞（AV 阻滞）模式。其余 150 例患者显示窦性心律。经导管组中有 104 例和手术组中有 96 例患者至少获得了一次术后随访动态心电图记录。在经导管闭合的 104 例患者中，97 例（93.3%）的动态心电图检查结果正常，7 例（6.7%）有心律失常。在接受手术闭合的 96 例患者中，85 例（88.5%）的动态心电图检查结果正常，11 例（11.5%）有心律失常。心律失常的发生率无统计学差异（P=0.164）。
与儿科年龄组相比，成人研究中心律失常的发生率更高，再次证明了儿童时期早期诊断和治疗 ASD 的重要性。两组心律失常发生率相似，支持两种闭合方法在合适患者中的安全性和有效性。
