Abu-Tair Tariq, Martin Claudia, Wiethoff Christiane M, Kampmann Christoph
Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany.
Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany.
J Clin Med. 2023 May 28;12(11):3717. doi: 10.3390/jcm12113717.
A 24 h Holter study in children after transcatheter secundum ASD (ASD II) closure was conducted to detect the prevalence of defects and/or device-related late atrial arrhythmias (LAAs). ASD II closure with an Amplatzer septal occluder (ASO) is an established procedure. Little is known about LAAs after device implantation.
The eligible participants were children who had undergone ASO implantation, with a follow-up of ≥5 years, as well as one pre- and at least one post-procedural Holter ECG.
In total, 161 patients (mean age: 6.2 ± 4.3 years), with a mean follow-up of 12.9 ± 3.1 years (range 5-19), were included. A median of four Holter ECGs per patient were available. LAAs occurred before intervention in four patients (2.5%), and it was peri-interventional in four patients (2.5%), sustained in three patients (1.9%), and developed in three patients (1.9%). In patients with pre- and peri-interventional LAAs, the Qp/Qs ratio was higher (6.4 ± 3.9 vs. non-AA: 2.0 ± 1.1 ( = 0.002)) and the IAS/ASO ratio was lower (1.18 ± 0.27 vs. non-AA: 1.7 ± 0.4 ( < 0.001)). The patients with LAAs differed from those without LAAs in their Qp/Qs (6.8 ± 3.5 vs. 2.0 ± 1.3; < 0.0001) and IAS/ASO ratios (1.14 ± 0.19 vs. 1.73 ± 0.45; < 0.001). The patients with LAAs had a Qp/Qs ratio ≥2.94:1, and those who developed LAAs had an IAS/ASO ratio <1.15.
LAAs occurred in 1.9% of patients and were sustained in another 1.9% of patients but persisted in those with large shunt defects and large occluders in relation to the atrial septal length. The predisposing factors for LAAs after ASD closure were a high Qp/Qs ratio, pre-existing atrial arrhythmias, and a low IAS/ASO ratio.
对经导管继发孔房间隔缺损（ASD II）封堵术后儿童进行24小时动态心电图监测研究，以检测缺损和/或与装置相关的晚期房性心律失常（LAA）的发生率。使用Amplatzer房间隔封堵器（ASO）封堵ASD II是一种成熟的手术方法。关于装置植入后LAA的情况知之甚少。
符合条件的参与者为接受ASO植入术且随访时间≥5年的儿童，以及术前和术后至少一次动态心电图监测。
共纳入161例患者（平均年龄：6.2±4.3岁），平均随访时间为12.9±3.1年（范围5 - 19年）。每位患者平均有4份动态心电图监测记录。4例患者（2.5%）在干预前出现LAA，4例患者（2.5%）在围手术期出现LAA，3例患者（1.9%）持续存在LAA，3例患者（1.9%）新发LAA。在术前和围手术期出现LAA的患者中，Qp/Qs比值较高（6.4±3.9 vs非LAA患者：2.0±1.1（P = 0.002）），而房间隔/ASO比值较低（1.18±0.27 vs非LAA患者：1.7±0.4（P < 0.001））。出现LAA的患者与未出现LAA的患者在Qp/Qs比值（6.8±3.5 vs 2.0±1.3；P < 0.0001）和房间隔/ASO比值（1.14±0.19 vs 1.73±0.45；P < 0.001）方面存在差异。出现LAA的患者Qp/Qs比值≥2.94:1，新发LAA的患者房间隔/ASO比值<1.15。
1.9%的患者出现LAA，另有1.9%的患者LAA持续存在，但在那些存在大分流缺损且相对于房间隔长度封堵器较大的患者中LAA持续存在。ASD封堵术后LAA的易感因素包括高Qp/Qs比值、既往存在的房性心律失常和低房间隔/ASO比值。
