IMPROVEMENT IN NONINVASIVE ELECTROPHYSIOLOGIC FINDINGS IN CHILDREN AFTER TRANSCATHETER ATRIAL SEPTAL-DEFECT CLOSURE

To evaluate whether transcatheter closure of secundum atrial septal de fects (ASD) affected noninvasive electrophysiologic variables in child ren, we reviewed the preprocedural and I-year postprocedural electroca rdiograms and Holter recordings of 18 consecutive children referred fo r ASD closure, Patients included in the study were a mean of 5.0 years old (SD 1.1) and weighed a mean of 17.9 kg (SD 4.1), ASDs had a mean diameter of 14.0 mm (SD 2.4) and average shunt ratio (pulmonary-to-sys temic flow) of 2.1:1, One year after occluder device placement, 9 chil dren (50%) had detectable residual shunts by transthoracic echocardiog rams, but only 2 (11%) had shunts that were felt to be possibly signif icant, One or more fractured occluder legs were noted by chest roentge nogram in 15 patients (83%), Electrocardiograms at follow-up demonstra ted improvement in right ventricular dilation in 4 of 7 patients, righ t atrial enlargement in 3 of 4 patients, and 1 degrees atrioventricula r block in 2 of 3 patients, Halter recordings showed a decreased incid ence of accelerated atrial rhythm in 3 of 7 patients, prolonged juncti onal escape rhythm in 2 of 2 patients, and premature atrial contractio ns in 2 of 2 patients. No finding correlated with patient age, defect or occluder diameter, occluder leg fracture(s), or residual defects. T hese Improvements in electrophysiologic abnormalities compare favorabl y with changes seen 1 year after surgical closure. In conclusion, plac ement of a transcatheter ASD device in children diminishes noninvasive electrophysiologic abnormalities at I-year follow-up, By relieving he modynamic stress caused by an ASD in childhood, ct transcatheter devic e may prevent arrhythmia disturbance later in life.