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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Reversible atrioventricular block associated with closure of atrial septal defects using the amplatzer device

Kenji Suda, MD^*, Marie-Josée Raboisson, MD, Eric Piette^*, Nagib S. Dahdah, MD, FACC^,* and Joaquim Miró, MD, FRCP

^* Division of Pediatric Cardiology, Department of Pediatrics, Tenri Hospital, Tenri, Japan
Department of Cardiology, Hôpital Louis Pradel, Lyon, France
Division of Cardiology, Hôpital Sainte-Justine, University of Montreal, Montreal, Canada

Manuscript received July 30, 2003; revised manuscript received October 1, 2003, accepted December 9, 2003.

^* Reprint requests and correspondence: Dr. Nagib S. Dahdah, Hôpital Sainte-Justine, Department of Cardiology, 3175 Cote St. Catherine, Montreal QC H3T1C-5, Canada.
ndahdah{at}pol.net

OBJECTIVES: We sought to determine the incidence, nature, and predisposing factors of atrioventricular block (AVB) associated with closure of atrial septal defects (ASDs) using the Amplatzer septal occluder (ASO).

BACKGROUND: In our institution, 162 patients underwent ASD closure using ASO between December 1997 and December 2001. This includes small children with large defects.

METHODS: Electrocardiographic tracings during ASO implantation and at follow-up visits were reviewed. Anatomic characteristics and device size were assessed as potential risk factors for AVB.

RESULTS: Ten patients (6.2%) presented with new-onset (n = 9) or aggravation of preexisting (n = 1) AVB. Atrioventricular block occurred during the procedure (n = 3) or was first noted one day to one week later (n = 7). Patients had first-degree (n = 4), second-degree Wenckebach (n = 4), or third-degree (n = 2) AVB, with no symptoms or hemodynamic compromise. First-degree AVB persisted in two patients at 12 and 33 months of follow-up, whereas most recovered normal AV conduction within one (n = 7) or six months (n = 1). A larger shunt (Qp/Qs ratio 2.8 ± 0.9 vs. 2.1 ± 0.8, p < 0.01) and device size (24 ± 5 vs. 19 ± 6 mm, p < 0.01) were the only determinant factors for AVB. A device size 19 mm was used in 90% (9 of 10) of patients who developed AVB, as compared with 49% of those without AVB (p < 0.02).

CONCLUSIONS: Closure of ASDs using the large ASO can be associated with the development of AV block and mandate a closer follow-up. In our series, however, all AVBs resolved or improved spontaneously, with no recurrence at mid-term follow-up.

Abbreviations and Acronyms   ASD = atrial septal defect   ASO = Amplatzer septal occluder   AV = atrioventricular   AVB = atrioventricular block   ECG = electrocardiogram or electrocardiographic   Qp/Qs = pulmonary to systemic flow ratio

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