Transkateter Atriyal Septal Defekt kapatma sonrası gelişen aritmiler: Tek merkez izlem sonuçları

Öz

Amaç: En sık görülen konjenital kalp hastalıklarından biri olan Atriyal Septal Defekt (ASD), çocukluk çağında genellikle asemptomatiktir ancak aritmi, inme, kalp yetersizliği ve pulmoner hipertansiyon gibi uzun vadeli sonuçlarla ilişkilidir. Çalışmamızda merkezimizdeki deneyimlerimizi sunarak transkateter ASD kapatma sonrası karşılaştığımız aritmiler, olası risk faktörleri ve seyri hakkında bilgi vermeyi amaçladık. Metod: Çalışmamız 2010-2020 yılları arasında kliniğimizde transkateter ASD kapatma işlemi uygulanan hastaların dosyalarının geriye dönük olarak taranarak değerlendirildiği kesitsel tanımlayıcı bir çalışmadır. Çalışmamıza toplam 216 hasta dahil edildi (131 kız %60,6, 85 erkek %39,4). ASD kapatılması sonrası gelişen aritmileri tespit etmek amaçlandığı için hastaların takip süresi daha uzun olmasına rağmen özellikle işlem sonrası ilk 6 aya ait veriler değerlendirildi. Değerlendirilen bu veriler: EKG bulguları, varsa hastaların ifade ettiği şikayetler ve buna göre gerekli görülen 24 saatlik ritim Holter sonuçları. Sonuçlar: Çalışmamıza dosyalarında verilerine ulaşılabilen 216 hasta (131 kız %60,6, 85 erkek %39,4) dahil edildi. Hastaların yaş ortalaması 79±48,5 ay (en az 30 ay, en fazla 17 yıl) idi. Hastaların ortalama ASD boyutu 14,27±3,85 mm (min: 9 mm, maks:26 mm), ortalama cihaz boyutu ise 16,8±3,7 mm (min: 10 mm, maks: 28 mm) idi. İşlem öncesi hastaların tamamı sinüs ritmindeydi. Çalışmaya dahil edilen 216 hastanın 13'ünde kapatma işlemi sonrasında aritmi tespit edildi. Kapatma sonrası aritmi oranı %6 idi. Aritmisi olan 13 hastanın 6'sında supraventriküler erken atım (SVE), 2'sinde ventriküler erken atım (VES), 2 hastada supraventriküler taşikardi (SVT), 1 hastada 1. derece AV blok, 1 hastada 2. derece AV blok ve 1 hastada 3. derece AV blok tespit edildi. Sonuç: Transkateter tedavi sonrasında gelişen aritmiler yaygın değildir ve genellikle geçicidir. En iyi seçenek, her hastayı ayrı ayrı değerlendirip mümkün olan en uygun yaşta kapatmaya karar vermektir.

Anahtar Kelimeler

• atriyal septal defekt
• aritmi
• transkateter

Arrhythmias developing after Transcatheter Atrial Septal Defect closure: Single-center follow-up results

Öz

Objective: Atrial Septal Defect (ASD), one of the most common congenital heart diseases, is usually asymptomatic in childhood, but is associated with long-term consequences such as arrhythmia, stroke, heart failure and pulmonary hypertension. In our study, we aimed to present our experiences in our center and provide information about the arrhythmias we encountered after transcatheter ASD closure, possible risk factors and their course. Methods: In our study, the files of patients who underwent transcatheter ASD closure in our clinic between 2010 and 2020 were retrospectively scanned. It is a cross-sectional descriptive study. A total of 216 patients were included in our study (131 girls 60.6%, 85 boys 39.4%).. Since our study aimed to detect arrhythmias that developed after ASD closure, even though the follow-up period was long the data especially in the f irst 6 months after the procedure were evaluated. These evaluated data are: ECG findings, complaints expressed by the patients, if any, and 24-hour rhythm Holter results deemed necessary accordingly. Results: 216 patients (131 girls 60.6%, 85 boys 39.4%) whose data could be accessed in their files were included in our study. The mean age of the patients was 79±48.5 months (min 30 months, max:17 years ). The average ASD size of the patients was 14.27±3.85 mm (min: 9 mm, max:26 mm) and the mean device size was 16.8±3.7 mm (min: 10mm, max: 28 mm). All the patients were at sinus rhythm prior to procedure. Arrhythmia was detected in 13 of the 216 patients included in the study after the closure procedure. The arrhythmia rate after closure was 6%. Of the 13 patients with arrhythmia, supraventricular premature beat (SVE) was detected in 6, ventricular premature beat (VES) in 2, supraventricular tachycardia (SVT) in 2 patients, 1st degree AV block in 1 patient, 2nd degree AV block in 1 patient and 3rd degree AV block in 1 patient. Conclusions: Arrhythmias that develop after transcatheter treatment are not common and are usually temporary. The best option is to evaluate each patient individually and decide on closure at the most appropriate age possible.

Anahtar Kelimeler

• ASD
• arrhythmia
• transcatheter closure

Kaynakça

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