Electrical Remodeling Following Atrial Septal Defect Closure in Adults: A Prospective Cohort Study
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Keywords
ASD, Congenital Heart Defects, Atrium, Closure, Trans-catheter, QTc, Surgery
Abstract
Atrial septal defects (ASDs) are a common type of congenital heart anomaly, accounting for approximately 10% of all such defects. The closure of an ASD with a substantial left-to-right shunt can lead to enhanced functional capacity and a reduction in arrhythmias. However, the closure of ASDs in adult patients carries certain risks, including the potential development of pulmonary edema and heart failure.
Objectives: The study aimed to assess atrial electrical function in adult patients with ASD before and 3 months after either transcatheter or surgical closure.
Material and methods: A prospective cohort study was conducted involving 40 adult patients (age ≥ 40 years) diagnosed with ostium secundum ASD and 20 age-matched healthy individuals serving as controls. The primary objective of this study was to investigate and compare the atrial electrical function in patients with ASD, both before and 3 months following the closure of the defect.
Results: The mean duration of the P wave in the case group was significantly higher than the mean duration of the P wave in the control group (p-value 0.001). A highly statistically significant difference in the mean QRS duration in the case group was higher than in the control group (p-value <0.001). A highly statistically significant difference between ECG parameters (HR, P wave duration, QRS width & QTc interval) before and after ASD closure (p-value <0.001). Also, there was a highly statistically significant difference before and after ASD closure (p-value < 0.001) regarding inter-atrial and intra-atrial conduction time (PA) involving PA lateral, septal & tricuspid in addition to atrial electromechanical delay (EMD).
Conclusions: The atrial geometrical and electrical reverse remodeling was evident at 3 months following ASD closure. Atrial enlargement is a substrate for developing atrial arrhythmia. Finally, ASD closure in older patients is safe and effective.
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