Electrical remodeling after percutaneous atrial septal defect closure in pediatric and adult patients

Vivian P Kamphuis; Martina Nassif; Sum-Che Man; Cees A Swenne; Jan A Kors; A Suzanne Vink; Arend D J Ten Harkel; Arie C Maan; Barbara J M Mulder; Rob J de Winter; Nico A Blom

doi:10.1016/j.ijcard.2019.02.020

Electrical remodeling after percutaneous atrial septal defect closure in pediatric and adult patients

Vivian P Kamphuis
, Martina Nassif
, Sum-Che Man
, Cees A Swenne
, Jan A Kors
, A Suzanne Vink
, Arend D J Ten Harkel
, Arie C Maan
, Barbara J M Mulder
, Rob J de Winter
, Nico A Blom

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Several studies have reported changes in electrocardiographic variables after atrial septal defect (ASD) closure. However no temporal electro-and vectorcardiographic changes have been described from acute to long-term follow-up at different ages. We aimed to study electrical remodeling after percutaneous ASD closure in pediatric and adult patients.

METHODS: ECGs of 69 children and 75 adults (median age 6 [IQR 4-11] years and 45 [IQR 33-54] years, respectively) were retrospectively selected before percutaneous ASD closure and at acute (1-7 days), intermediate (4-14 weeks) and late (6-18 months) follow-up. Apart from electrocardiographic variables, spatial QRS-T angle and ventricular gradient (VG) were derived from mathematically-synthesized vectorcardiograms.

RESULTS: In both pediatric and adult patients, the heart rate decreased immediately post-closure, which persisted to late follow-up. The P-wave amplitude also decreased acutely post-closure, but remained unchanged at later follow-up. The PQ duration shortened immediately in children and at intermediate follow-up in adults. The QRS duration and QTc interval decreased at intermediate-term follow-up in both children and adults. In both groups the spatial QRS-T angle decreased at late follow-up. The VG magnitude increased at intermediate follow-up in children and at late follow-up in adults, after an initial decrease in children.

CONCLUSION: In both pediatric and adult ASD patients, electrocardiographic changes mainly occurred directly after ASD closure except for shortening of QRS duration and QTc interval, which occurred at later follow-up. Adults also showed late changes in PQ duration. At 6-to-18 month post-closure, the spatial QRS-T angle decreased, reflecting increased electrocardiographic concordance. The initial acute decrease in VG in children, which was followed by a significant increase, may be the effect of action potential duration dynamics directly after percutaneous ASD closure.

Original language	English
Pages (from-to)	32-39
Number of pages	8
Journal	International Journal of Cardiology
Volume	285
DOIs	https://doi.org/10.1016/j.ijcard.2019.02.020
Publication status	Published - 15 Jun 2019
Externally published	Yes

Keywords

Adult
Atrial Remodeling/physiology
Cardiac Catheterization/methods
Cardiac Surgical Procedures/methods
Child
Child, Preschool
Echocardiography
Electrocardiography
Female
Follow-Up Studies
Heart Rate/physiology
Heart Septal Defects, Atrial/physiopathology
Heart Ventricles/diagnostic imaging
Humans
Male
Middle Aged
Retrospective Studies
Septal Occluder Device
Time Factors
Vectorcardiography/methods

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10.1016/j.ijcard.2019.02.020

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Kamphuis, V. P., Nassif, M., Man, S.-C., Swenne, C. A., Kors, J. A., Vink, A. S., Ten Harkel, A. D. J., Maan, A. C., Mulder, B. J. M., de Winter, R. J., & Blom, N. A. (2019). Electrical remodeling after percutaneous atrial septal defect closure in pediatric and adult patients. International Journal of Cardiology, 285, 32-39. https://doi.org/10.1016/j.ijcard.2019.02.020

@article{8f226bd1bd394c77bbbdec63d199e419,

title = "Electrical remodeling after percutaneous atrial septal defect closure in pediatric and adult patients",

abstract = "BACKGROUND: Several studies have reported changes in electrocardiographic variables after atrial septal defect (ASD) closure. However no temporal electro-and vectorcardiographic changes have been described from acute to long-term follow-up at different ages. We aimed to study electrical remodeling after percutaneous ASD closure in pediatric and adult patients.METHODS: ECGs of 69 children and 75 adults (median age 6 [IQR 4-11] years and 45 [IQR 33-54] years, respectively) were retrospectively selected before percutaneous ASD closure and at acute (1-7 days), intermediate (4-14 weeks) and late (6-18 months) follow-up. Apart from electrocardiographic variables, spatial QRS-T angle and ventricular gradient (VG) were derived from mathematically-synthesized vectorcardiograms.RESULTS: In both pediatric and adult patients, the heart rate decreased immediately post-closure, which persisted to late follow-up. The P-wave amplitude also decreased acutely post-closure, but remained unchanged at later follow-up. The PQ duration shortened immediately in children and at intermediate follow-up in adults. The QRS duration and QTc interval decreased at intermediate-term follow-up in both children and adults. In both groups the spatial QRS-T angle decreased at late follow-up. The VG magnitude increased at intermediate follow-up in children and at late follow-up in adults, after an initial decrease in children.CONCLUSION: In both pediatric and adult ASD patients, electrocardiographic changes mainly occurred directly after ASD closure except for shortening of QRS duration and QTc interval, which occurred at later follow-up. Adults also showed late changes in PQ duration. At 6-to-18 month post-closure, the spatial QRS-T angle decreased, reflecting increased electrocardiographic concordance. The initial acute decrease in VG in children, which was followed by a significant increase, may be the effect of action potential duration dynamics directly after percutaneous ASD closure.",

keywords = "Adult, Atrial Remodeling/physiology, Cardiac Catheterization/methods, Cardiac Surgical Procedures/methods, Child, Child, Preschool, Echocardiography, Electrocardiography, Female, Follow-Up Studies, Heart Rate/physiology, Heart Septal Defects, Atrial/physiopathology, Heart Ventricles/diagnostic imaging, Humans, Male, Middle Aged, Retrospective Studies, Septal Occluder Device, Time Factors, Vectorcardiography/methods",

author = "Kamphuis, \{Vivian P\} and Martina Nassif and Sum-Che Man and Swenne, \{Cees A\} and Kors, \{Jan A\} and Vink, \{A Suzanne\} and \{Ten Harkel\}, \{Arend D J\} and Maan, \{Arie C\} and Mulder, \{Barbara J M\} and \{de Winter\}, \{Rob J\} and Blom, \{Nico A\}",

note = "Publisher Copyright: {\textcopyright} 2019 The Authors",

year = "2019",

month = jun,

day = "15",

doi = "10.1016/j.ijcard.2019.02.020",

language = "English",

volume = "285",

pages = "32--39",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Electrical remodeling after percutaneous atrial septal defect closure in pediatric and adult patients

AU - Kamphuis, Vivian P

AU - Nassif, Martina

AU - Man, Sum-Che

AU - Swenne, Cees A

AU - Kors, Jan A

AU - Vink, A Suzanne

AU - Ten Harkel, Arend D J

AU - Maan, Arie C

AU - Mulder, Barbara J M

AU - de Winter, Rob J

AU - Blom, Nico A

PY - 2019/6/15

Y1 - 2019/6/15

N2 - BACKGROUND: Several studies have reported changes in electrocardiographic variables after atrial septal defect (ASD) closure. However no temporal electro-and vectorcardiographic changes have been described from acute to long-term follow-up at different ages. We aimed to study electrical remodeling after percutaneous ASD closure in pediatric and adult patients.METHODS: ECGs of 69 children and 75 adults (median age 6 [IQR 4-11] years and 45 [IQR 33-54] years, respectively) were retrospectively selected before percutaneous ASD closure and at acute (1-7 days), intermediate (4-14 weeks) and late (6-18 months) follow-up. Apart from electrocardiographic variables, spatial QRS-T angle and ventricular gradient (VG) were derived from mathematically-synthesized vectorcardiograms.RESULTS: In both pediatric and adult patients, the heart rate decreased immediately post-closure, which persisted to late follow-up. The P-wave amplitude also decreased acutely post-closure, but remained unchanged at later follow-up. The PQ duration shortened immediately in children and at intermediate follow-up in adults. The QRS duration and QTc interval decreased at intermediate-term follow-up in both children and adults. In both groups the spatial QRS-T angle decreased at late follow-up. The VG magnitude increased at intermediate follow-up in children and at late follow-up in adults, after an initial decrease in children.CONCLUSION: In both pediatric and adult ASD patients, electrocardiographic changes mainly occurred directly after ASD closure except for shortening of QRS duration and QTc interval, which occurred at later follow-up. Adults also showed late changes in PQ duration. At 6-to-18 month post-closure, the spatial QRS-T angle decreased, reflecting increased electrocardiographic concordance. The initial acute decrease in VG in children, which was followed by a significant increase, may be the effect of action potential duration dynamics directly after percutaneous ASD closure.

AB - BACKGROUND: Several studies have reported changes in electrocardiographic variables after atrial septal defect (ASD) closure. However no temporal electro-and vectorcardiographic changes have been described from acute to long-term follow-up at different ages. We aimed to study electrical remodeling after percutaneous ASD closure in pediatric and adult patients.METHODS: ECGs of 69 children and 75 adults (median age 6 [IQR 4-11] years and 45 [IQR 33-54] years, respectively) were retrospectively selected before percutaneous ASD closure and at acute (1-7 days), intermediate (4-14 weeks) and late (6-18 months) follow-up. Apart from electrocardiographic variables, spatial QRS-T angle and ventricular gradient (VG) were derived from mathematically-synthesized vectorcardiograms.RESULTS: In both pediatric and adult patients, the heart rate decreased immediately post-closure, which persisted to late follow-up. The P-wave amplitude also decreased acutely post-closure, but remained unchanged at later follow-up. The PQ duration shortened immediately in children and at intermediate follow-up in adults. The QRS duration and QTc interval decreased at intermediate-term follow-up in both children and adults. In both groups the spatial QRS-T angle decreased at late follow-up. The VG magnitude increased at intermediate follow-up in children and at late follow-up in adults, after an initial decrease in children.CONCLUSION: In both pediatric and adult ASD patients, electrocardiographic changes mainly occurred directly after ASD closure except for shortening of QRS duration and QTc interval, which occurred at later follow-up. Adults also showed late changes in PQ duration. At 6-to-18 month post-closure, the spatial QRS-T angle decreased, reflecting increased electrocardiographic concordance. The initial acute decrease in VG in children, which was followed by a significant increase, may be the effect of action potential duration dynamics directly after percutaneous ASD closure.

KW - Adult

KW - Atrial Remodeling/physiology

KW - Cardiac Catheterization/methods

KW - Cardiac Surgical Procedures/methods

KW - Child

KW - Child, Preschool

KW - Echocardiography

KW - Electrocardiography

KW - Female

KW - Follow-Up Studies

KW - Heart Rate/physiology

KW - Heart Septal Defects, Atrial/physiopathology

KW - Heart Ventricles/diagnostic imaging

KW - Humans

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Septal Occluder Device

KW - Time Factors

KW - Vectorcardiography/methods

U2 - 10.1016/j.ijcard.2019.02.020

DO - 10.1016/j.ijcard.2019.02.020

M3 - Article

C2 - 30857845

SN - 0167-5273

VL - 285

SP - 32

EP - 39

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Electrical remodeling after percutaneous atrial septal defect closure in pediatric and adult patients

Abstract

Keywords

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