[Przezskórne zamkniecie ubytku w przegrodzie miedzyprzedsionkowej: wplyw na prawy przedsionek, dyspersje zalamka P i zaburzenia rytmu serca w obserwacji srednioterminowej]. / Transcatheter closure of atrial septal defect: impact on right atrium, P-wave dispersion and arrhythmias in mid-term follow-up.

The size of the right atrium (RA) reduces after transcatheter closure of the atrial septal defect (ASD). Inverse structural and electrical remodeling is observed. AIM: The aim of study was to analyze the parameters predisposing to the lack of normalization of enlarged RA after transcatheter closure of ASD during 6-month follow-up. MATERIALS AND METHODS: A prospective study included 56 consecutive adult patients (12 men) aged from 23 to 76 years (49.8±13.3 years) with ASD, in whom transcatheter ASD closure was performed. Each patient was assessed before and 6 months after the treatment using standard 12-lead resting electrocardiogram (ECG), 24-hour Holter monitoring and echocardiography. RESULTS: Before the procedure in 37 patients with ASD enlarged RA was observed, while after transcatheter ASD closure in 24 patients normalization of enlarged RA was noted. Patients in whom 6 months after the procedure there was no normalization of the enlarged RA were older, characterized by higher right ventricular systolic pressure (RVSP), pulmonary to systemic blood flow ratio (Qp/Qs), larger size of the occluder, interatrial septal defect, longer fluoroscopy time and lower left ventricular ejection fraction. P-wave dispersion (Pdysp) was found to be a destimulant i.e. increased Pdysp (>67 ms, P<0.000) decreased the chance of RA normalization after procedure. On the other hand, minimum P-wave duration (Pmin) was a stimulant, therefore, increased Pmin (>72ms, P<0.000) increased the chance of RA normalization. A significant association was found between the reduction of supraventricular extrasystolic beats and RA area normalization (P<0.001), and there was no association between the incidence of atrial fibrillation episodes and RA area normalization. CONCLUSIONS: Evaluation of the duration of the P-wave and its dispersion may help to assess the prognosis of the right atrium size normalization in the mid-term follow-up after transcatheter closure of ASD. There is a significant relationship between normalization of the right atrium size and reduction of supraventricular extrasystolic beats.

Transcatheter closure of atrial septal communication: Impact on quality of life in mid-term follow-up.

BACKGROUND: Atrial septal defect (ASD) and patent foramen ovale (PFO) are specific types of atrial septal communications (ASC). OBJECTIVES: We aimed to assess quality of life (QoL) in patients before and after percutaneous closure of ASC and determine the factors influencing QoL in this group of patients. MATERIAL AND METHODS: We performed a clinical assessment and conducted an SF-36 questionnaire, electrocardiography and echocardiography studies in patients before and 6 months after percutaneous ASC closure. RESULTS: Patients with ASD (n = 56) had a lower SF-36 total score than those with PFO (n = 73), before and after percutaneous ASC occlusion (both p < 0.001). After the procedure, the improvement of SF-36 total score in patients with ASD or atrial fibrillation was greater (p < 0.001 and p = 0.005, respectively). We observed correlations between improvement of QoL and baseline supraventricular extrasystolic beats (rs = 0.28; p = 0.002), but not ventricular extrasystolic beats (rs = 0.03; p = 0.76). Quality of life improvement was predicted in patients with ASD by higher baseline tricuspid annular plane systolic excursion (TAPSE) and right ventricular longitudinal dimension R2 = 0.38; p < 0.001. However, in patients with PFO, this was predicted by TAPSE, lack of arterial hypertension and usage of angiotensin-converting enzyme inhibitors, R2 = 0.30; p < 0.001. CONCLUSIONS: Patients with ASD have lower QoL than those with PFO before and after percutaneous ASC occlusion. Six months after the procedure, the improvement of QoL in patients with ASD was higher than in those with PFO. The change in QoL self-assessed by patients after the procedure was associated with episodes of arrhythmia and was predicted with echocardiographic and clinical parameters.