Assessment of cardiac arrhythmia in children after percutaneous closure of secundum atrial septal defect with the Amplatzer Septal Occluder

Abstract

Background: Transcatheter closure of secundum atrial septal defect (ASD II) with the Amplatzer Septal Occluder (ASO) in children is an alternative method to surgical closure. The aim of this study was to analyse arrhythmia in the early period after percutaneous closure of ASD II in children.
Methods: In the group of 60 children aged 4.5-18.5 years (av. 10 years) arrhythmia evaluation was performed prior to the procedure and 24 hours and 1 year afterwards. All patients underwent standard ECG and 29 of them also underwent 24-hour Holter ECG monitoring.
Results: Prior to closure 59 children had sinus rhythm and 1 child had a low atrial rhythm. In Holter ECG intermittent junctional rhythm was recorded in 2 children, Wenckebach block in 1 and 400 single supraventricular ectopy (SVE) also in 1 child. Twenty-four hours after the procedure arrhythmia was found in 5 patients. In four children with arrhythmia 100 to 10000 SVE was recorded and non-sustained supraventricular tachycardia (SVT) in 2 of them. In 1 child single ventricular ectopic beats coexisted. One patient developed symptomatic atrial flutter/fibrillation after 3 weeks. After 1 year ECG Holter monitoring showed that 2 patients had non-sustained SVT. None of the 4 girls with SVE immediately after the procedure had arrhythmia 1 year later. There were no changes in baseline rhythm according to the assessment made 1 year following closure.
Conclusion: New asymptomatic supraventricular dysrhythmias occurring at 24 hours after percutaneous ASD II closure could result from the ASO device. Serious symptomatic arrhythmia is rare in children after the procedure, but further studies are required.