Assessment of atrial function and rhythm after percutaneous closure of atrial septal defect

Abstract

Background: Secundum atrial septal defect (ASD) is one of the most common congenital heart conditions. Transcatheter device closure of secundum ASD has become the preferred treatment for patients with suitable anatomy. While, the impact on ventricular function and volume post-closure has been widely studied, data on atrial performance following percutaneous ASD closure remains limited.
Objective: This study aimed to assess atrial function using echocardiographic modalities and atrial rhythm through Holter monitoring early after percutaneous ASD closure.
Patients and Methods: The study included 40 patients with secundum ASD, evaluated before and shortly after percutaneous closure. Atrial performance was assessed using two-dimensional echocardiography, tissue Doppler imaging (TDI) velocities, and speckle-tracking echocardiography (STE) to measure reservoir, conduit, and contractile functions. Electrical function was monitored with electrocardiograms (ECG) and Holter monitoring to detect heart rate (HR) rhythms and heart rate variability (HRV) before and after ASD closure.
Results: Right atrial diameters, volumes, and TDI velocities significantly decreased post-closure. RA reservoir function dropped from 34.58 ± 11.69 before closure to 28.73 ± 11.52 after closure (p<0.001). Similarly, LA reservoir function decreased from 31.4 ± 7.28 to 27.08 ± 6.93 (p<0.001). Average HR decreased from 98.08 ± 13.51 bpm to 92.05 ± 13.23 bpm (p<0.001). The incidence of supraventricular arrhythmia increased significantly post-closure (0.41 ± 0.46%) compared to pre-closure (0.08 ± 0.19%; p<0.001).
Conclusion: Atrial diameters and volumes decreased early after ASD device closure, along with reductions in atrial reservoir, conduit, and contractile functions. Supraventricular arrhythmias increased, but there was an improvement in HR and HRV parameters post-closure.