Vivian P Kamphuis1, Martina Nassif2, Sum-Che Man3, Cees A Swenne4, Jan A Kors5, A Suzanne Vink6, Arend D J Ten Harkel7, Arie C Maan8, Barbara J M Mulder9, Rob J de Winter10, Nico A Blom11. 1. Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands. Electronic address: v.p.kamphuis@lumc.nl. 2. Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: m.nassif@amc.uva.nl. 3. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: s.man@lumc.nl. 4. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: C.A.Swenne@lumc.nl. 5. Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: j.kors@erasmusmc.nl. 6. Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: a.s.vink@amc.uva.nl. 7. Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: A.D.J.ten_Harkel@lumc.nl. 8. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: A.C.Maan@lumc.nl. 9. Netherlands Heart Institute, Utrecht, the Netherlands; Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: b.j.mulder@amc.uva.nl. 10. Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: r.j.dewinter@amc.uva.nl. 11. Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: N.A.Blom@lumc.nl.
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.
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.
Authors: Hou Bo; David Heinzmann; Christian Grasshoff; Peter Rosenberger; Christian Schlensak; Meinrad Gawaz; Jürgen Schreieck; Harald F Langer; Johannes Patzelt; Peter Seizer Journal: Clin Cardiol Date: 2019-09-09 Impact factor: 2.882