Early Progressive Atrioventricular Block After Amplatzer Septal Occluder Closure of a Large Atrial Septal Defect

Derek Williams,Yoshio Ootaki,Allison Welch

doi:10.24983/scitemed.acri.2019.00118

Abstract

Authors describe a 4-year-old boy with a moderate secundum atrial septal defect who developed rapidly progressive heart block after device closure. After surgical removal and patch closure he had gradual return to sinus rhythm. This report highlights the continued needed vigilance of heart block after atrial septal defect device closure.

Highlights

Risks for transcatheter device closure of secundum atrial septal defects (ASD) are low with the majority known to be thromboembolic events, erosion, nickel hypersensitivity, migraines, valvular damage, atrial arrhythmias, endocarditis, and conduction abnormalities [1,2,3,4,5]
We describe a case of progressive atrioventricular(AV) block in the first 12 hours after Amplatzer Septal Occluder (ASO) closure of a secundum ASD
The ASO seems to be the device of choice for moderate to large secundum ASDs as the other devices presently available do not have as great success achieving closure

Summary

INTRODUCTION

Risks for transcatheter device closure of secundum atrial septal defects (ASD) are low with the majority known to be thromboembolic events, erosion, nickel hypersensitivity, migraines, valvular damage, atrial arrhythmias, endocarditis, and conduction abnormalities [1,2,3,4,5]. His electrocardiogram (ECG) revealed normal sinus rhythm and rate for age as well as prominent right ventricular forces (Figure 1) His echocardiogram (ECHO) revealed a moderate to large secundum ASD with right atrial and ventricular dilation. 12 hours later telemetry revealed progression to 2nd degree AV block (2:1) with heart rates in the 60-bpm range (Figure 3B). The patient remained in 3rd degree heart block with a rate of 40 bpm the first two days after surgery so was atrial pacing paced using temporary epicardial pacing wires. He remained in sinus rhythm at his 1- and 4-week follow-up

DISCUSSION

CONCLUSION