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Pol. Merkur. Lek (Pol. Med. J.), 2019, XLVI/273: 109-114 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2019, XLVI/273: 109-114

Title: Transcatheter closure of atrial septal defect: impact on right atrium, P-wave dispersion and arrhythmias in mid-term follow-up 

Authors: Lelakowska M, Olszowska M, Matusik PT, Przewłocki T, Nessler J, Podolec N, Podolec P, Komar M. 

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SUMMARY IN POLISH & ENGLISH. FULL ARTICLE ONLY IN POLISH.

Transcatheter closure of atrial septal defect: impact on right atrium, P-wave dispersion and arrhythmias in mid-term follow-up


Lelakowska M1, Olszowska M2, Matusik PT3, Przewłocki T2, Nessler J4, Podolec N5, Podolec P2, Komar M2.

Jagiellonian University Medical College, the John Paul II Hospital, Kraków, Poland: 1Department of Coronary Disease and Heart Failure; 2Department of Cardiac and Vascular Diseases, Institute of Cardiology; 3Department of Electrocardiology, Institute of Cardiology; 4Department of Coronary Disease and Heart Failure, Institute of Cardiology; 5Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland

The size of the right atrium (RA) reduces after transcatheter closure of the atrial septal defect (ASD). Inverse structural and electrical remodeling is observed.
The aim of study
was to analyze the parameters predisposing to the lack of normalization of enlarged RA after transcatheter closure of ASD during 6-month follow-up.
Material and methods
. A prospective study included 56 consecutive adult patients (12 men) aged from 23 to 76 years (49.8±13.3 years) with ASD, in whom transcatheter ASD closure was performed. Each patient was assessed before and 6 months after the treatment using standard 12-lead resting electrocardiogram (ECG), 24-hour Holter monitoring and echocardiography.
Results
. Before the procedure in 37 patients with ASD enlarged RA was observed, while after transcatheter ASD closure in 24 patients normalization of enlarged RA was noted. Patients in whom 6 months after the procedure there was no normalization of the enlarged RA were older, characterized by higher right ventricular systolic pressure (RVSP), pulmonary to systemic blood flow ratio (Qp/Qs), larger size of the occluder, interatrial septal defect, longer fluoroscopy time and lower left ventricular ejection fraction. P-wave dispersion (Pdysp) was found to be a destimulant i.e. increased Pdysp (>67 ms, P<0.000) decreased the chance of RA normalization after procedure. On the other hand, minimum P-wave duration (Pmin) was a stimulant, therefore, increased Pmin (>72ms, P<0.000) increased the chance of RA normalization. A significant association was found between the reduction of supraventricular extrasystolic beats and RA area normalization (P<0.001), and there was no association between the incidence of atrial fibrillation episodes and RA area normalization.
Conclusions
. Evaluation of the duration of the P-wave and its dispersion may help to assess the prognosis of the right atrium size normalization in the mid-term follow-up after transcatheter closure of ASD. There is a significant relationship between normalization of the right atrium size and reduction of supraventricular extrasystolic beats.

Key words: ASD, right atrium, arrhythmias

Pol Med J, 2019; XLVI (273); 109–114