Retrospective evaluation of postoperative rhythm of patients undergoing ASD (Atrial Septal Defect) closure by surgical or transcatheter

Background and Aims: Atrial Septal Defect (ASD) is a common congenital heart disease. Although it is mostly asymptomatic in childhood, it may present with different clinical features in 3rd and 4th decades. Small (<4 mm) ASDs can be expected to self-close around 2-3 years of age. Larger ASDs can be closed by surgical or transcatheter way. In this study, postoperative ECG analysis of patients whose ASD closured by surgical or transcatheter method is performed and evaluated for rhythm disorders. Materials and Methods: This retrospective study included patients who were younger than 18 years of age, admitted to the pediatric cardiology department between October 1992 and December 2018, who had ASD detected by echocardiography, and who underwent surgical or transcatheter closure. Demographic data, complaints and physical examination findings of 140 cases with sufficient data were recorded. Echocardiography and electrocardiography records were analyzed before and after ASD closure procedure. Findings were compared across surgical and transcatheter closure groups and before and after the procedure. Risk factors for arrhythmia were determined. Complications, length of stay in the ward and intensive care unit, and duration of mechanical ventilation were compared. Results: Forty-nine (59.8%) of the patients who underwent surgical closure, 30 (51.7%) of the patients underwent transcatheter closure were female (p= 0.34). The median age of the surgical group was 58.31 (9.9-196.5) months and 90.95 (42.5-204.7) months in the catheter group (p<0,05). The mean body weight z-score was calculated as -0.69 ± 1.1 SDS in the surgical group and -0.2 ± 1.09 SDS in the catheter group (p = 0.01). There was a weak negative correlation between body weight-score and ASD diameter (R = -0.276, p = 0.01). It was found that 95% of the cases were asymptomatic and 86% had murmur. When the ASD dimensions were evaluated as millimeters, the median was 14.5 mm (4-35) in the surgical group and the median was 9.5 mm (4-20) in the transcatheter group (p <0.05). In both groups, the majority of ASDs were secundum type ASD. Pulmonary stenosis, tricuspid insufficiency and pulmonary hypertension were more common in the surgical group before the procedure (p <0.05). There was no statistically significant difference about echocardiography parameters (EF, FS, morphology) and ECG parameters (rhythm, axis degree, heart rate, PR-QRS-QTc duration and branch block) across groups before closure. After the procedure, only branch block and arrhythmia frequency were found to be statistically significant in the surgical group (p <0.05). In the surgical group, two patients had transient arrhythmias and four patients had persistent arrhythmias. When the risk factors (sex, age of operation, ASD diameter, PR, QRS, branch block) were evaluated for the development of arrhythmia, relative risk of the pre-procedure PR distance length (>172msn) was found to be 54.0 (95% CI: 3.25-196.83 p = 0.005). The relative risk of ASD diameter (>11mm) was 15.87 (95% CI: 0.92-272.64 p = 0.056). The relative risk of QRS duration (>86msn) was 11.25 (95% CI: 0.64-196.83 p = 0.09). The incidence of complications (surgery: 15.8%; transcatheter: 1.7%) and length of hospital stay (median hospitalization: surgery: 8 days; transcatheter: 3 days) were significantly higher in the surgical group (p <0.05). Conclusions: In the postoperative ECG analysis of patients who had surgical or transcatheter closure, there was no statistically significant difference in terms of PR, QRS, QTC, axis degree. Complications, length of stay and arrhythmia were more frequent in the surgical group. Advanced surgery age, long QRS and PR distance before the procedure and ASD diameter were found to be relatively risky for arrhythmia. Because of the insufficiency of the data before the procedure, statistical studies are not sufficient and only PR distance from these parameters increases the risk of arrhythmia in a statistically significant manner.