Ng Rui Lun, Karyostyko Boekhren, Ramli Mohd Nor Hisham, Tan Jason Weng Yew, Hamad Ibrahim Fakhri Elhadi, Azeman Nor Athirah, Leong Ming Chern
Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute of Malaysia), Kuala Lumpur, Malaysia.
Nor Athirah Azeman, Research Department, Institut Jantung Negara, Kuala Lumpur, Malaysia.
Int J Cardiol Congenit Heart Dis. 2022 May 24;9:100397. doi: 10.1016/j.ijcchd.2022.100397. eCollection 2022 Sep.
Patients >40 years with an atrial septal defect (ASD) may have atrial arrhythmia which warrants treatment. It is unclear whether preventive left atrial appendage (LAA) occlusion should be performed simultaneously during ASD closure in these patients.
This study aimed to examine the incidence of de novo atrial arrhythmia in patients >40 years old post transcatheter closure of ASD.
This was a single-center, retrospective study involving all consecutive patients who have undergone device closure of ASDs at age >40 years. Standard 12-lead ECGs were performed pre-procedure and during every clinic follow-up. Ambulatory monitors were applied when indicated.
Eighty-eight patients (mean age: 51.81 ± 8.01 years; male: 22.7%) were recruited and followed up over a median duration of 3.6 years (range: 1-6.5). Seven patients (8%) had documented atrial arrhythmia (AA) pre and post ASD closure. Two patients (2.5%) developed de novo atrial fibrillation and one patient (1.2%), ectopic atrial rhythm during follow-up. In univariate analyses, age >61.3 years (p < 0.001), a history of palpitation (p = 0.006), right atrial area >25.15cm2 pre-closure (p = 0.004); dilated right and left atrium immediately post ASD closure (p = 0.016 & 0.001) and pulmonary vascular resistance >1.31Woods unit (p = 0.036) were associated with increased risk of AA. However, on multivariate analyses, none were significantly associated with AA.
De novo atrial arrhythmia after ASD device closure is uncommon.
年龄大于40岁的房间隔缺损（ASD）患者可能会出现心房心律失常，需要进行治疗。目前尚不清楚在这些患者进行ASD封堵术时是否应同时进行预防性左心耳（LAA）封堵。
本研究旨在探讨年龄大于40岁的患者经导管封堵ASD后新发心房心律失常的发生率。
这是一项单中心回顾性研究，纳入了所有年龄大于40岁接受ASD封堵装置治疗的连续患者。术前及每次门诊随访时均进行标准12导联心电图检查。必要时应用动态监测仪。
共纳入88例患者（平均年龄：51.81±8.01岁；男性：22.7%），中位随访时间为3.6年（范围：1 - 6.5年）。7例患者（8%）在ASD封堵术前和术后记录有心房心律失常（AA）。2例患者（2.5%）在随访期间出现新发房颤，1例患者（1.2%）出现异位心律。单因素分析中，年龄大于61.3岁（p < 0.001）、有心悸病史（p = 0.006）、封堵术前右心房面积大于25.15cm²（p = 0.004）、ASD封堵术后即刻右心房和左心房扩张（p = 0.016和0.001）以及肺血管阻力大于1.31伍德单位（p = 0.036）与AA风险增加相关。然而，多因素分析中，这些因素均与AA无显著相关性。
ASD封堵装置术后新发心房心律失常并不常见。
