Atrial Arrhythmia in Atrial Septal Defect Patient: A Case Report and Review of Literature

https://doi.org/10.22146/aci.40857

Indah Paranita(1*), Lucia Kris Dinarti(2), Bambang Irawan(3)

(1) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta.
(2) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta.
(3) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta.
(*) Corresponding Author

Abstract


Atrial fibrillation (AF) and atrial flutter are the most common cardiac arrhythmias associated with atrial septal defects (ASD) in adult patients. The incidence could be as high as 52% in patients ages 60 years or more.Patient with congenital heart disease who developed atrial arrhythmias had a >50% increased stroke risk. Nevertheless, studies regarding the pathophysiological mechanism underlying the high incidence of atrial fibrillation in adult patients with ASD remain relatively few. We reported a female 46 years referred to Sardjito hospital with chest discomfort and palpitation. ECG showed atrial flutter, 90 beat per minute, incomplete RBBB, RAD and RVH. Transthoracal echocardiography shown ASD left to right shunt with diameter 1.2 -1.8 cm, LA, RA and RV dilatation, with normal systolic function. From right heart catetherization, the result is ASD High Flow Low Resistance, with pulmonary hypertension (mPAP 44 mmHg).The consequences of left to right shunt across an ASD is RV volume overload and pulmonary overcirculation. Atrial arrhytmia are a common result of long standing right side heart volume and pressure overload. The idea of combining ASD closure and arrhythmia intervention is another approach to consider.


Keywords


atrial fibrillation ; atrial septal defect; atrial arrhytmia

Full Text:

PDF


References

Blake G.E., Lakkireddy D. 2008. Atrial septal defect and atrial fibrillation: the known and unknown. J Atr Fibrillation, 1:45.

Berger F., Vogel M., Kramer A. 1999. Incidence of atrial flutter/ fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg, 68:75–78.

Bernstein D. 2007. ‘Congenital heart disease’. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, Nelson textbook of pediatrics, Edisi ke-18, Saunders Elsevier, Philadelphia,pp 1878-81.

Chubb H., Whitaker J., William S.E.,Head C.E., Chung N.A.Y., Wright M.J., et al. 2014. Patophysiology and management of arrhytmias associated with atrial septal defect and patent foramen ovale. Arrhythm Electrophysiol Rev, 3:168-172.

Camm A.J., Kirchhof P., Lip G.Y.H., Schotten U., Savelieva I., Ernst S., et al. 2010, Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J, 31:2369-2429.

Craig R.J., Selzer A. 1968. Natural history and prognosis of atrial septal defect. Circulation, 37:805-815.

Crandall M.A., Daoud E.G., Daniels C.J., Kalbflleisch S.J. 2012. Percutaneous radiofrequency catheter ablation for atrial fibrillation prior to atrial septal defect closure. J Cardiovasc electrophysiol, 23:102- 104.

Darby A.E., DiMarco J.P. 2012. Management of atrial fibrillation in patients with structural heart disease. Circulation, 125:945-957.

Gatzoulis M.A., Freeman M.A., Siu S.M., Webb G.D., Harris L. 1999. Atrial arrhytmia after surgical closure of atrial septal defect in adults. N Engl J Med, 340:839-846.

Gelernter-Yaniv L., Lorber A. 2007. The familial form of atrial septal defect. Acta Paediatr, 96: 726–730.

Lin J.L. 2009. Atrial fibrillation in atrial septal defect : A problem of right atrium or left atrium?, Heart Rhytm, 6:1007-1008.

Morton J.B., Sanders P., Vohra J.K., Sparks P.B., Morgan J.G., Spence S.J., et al. 2003. Effect of chronic right atrial stretch on atrial electrical remodeling in patients with an atrial septal defect. Circulation, 107:1775- 1782.

Oliver J.M., Gallego P., Gonzalez A., Benito F., Mesa J.M., Sobrino J.A., 2002, Predisposing condition for atrial fibrillation in atrial septal defect with and without operative closure. Am J Cardiol, 89:39-43.

Roberts-Thomson K.C., John B., Worthley S.G., Brooks A.G., Stiles M.K., Lau D.H., et al. 2009. Left atrial remodelling in patient with atrial septal defect. Heart Rhytm, 6:1000-1006.

Salehian O., Horlick E., Schwerzmann M., Haberer K., McLaughlin P., Siu S.C., et al. 2005. Improvements in cardiac form and function after transcatheter closure of secundum atrial septal defects. J Am Coll Cardiol, 45:499-504.

Santangeli P., Di Biase L., Burkhardt J.D., Horton R., Sanchez J., Bailey S., et al. 2011. Transeptal acces and atrial fibrillation ablation guided by intracardiac echocardiography in patient with atrial septal closure devices. Heart Rhythm, 8:1669-1675.



DOI: https://doi.org/10.22146/aci.40857

Article Metrics

Abstract views : 2419 | views : 3910

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 Indah Paranita, Lucia Kris Dinarti, Bambang Irawan

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.



ACI (Acta Cardiologia Indonesiana) is indexed by: 

   

  

ACI (Acta Cardiologia Indonesiana) is published by:

Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

Address: Radiopoetro Building 2nd Floor, West Wing, Farmako Street, Sekip, Yogyakarta, Indonesia 55281

ACI (Acta Cardiologia Indonesiana) is endorsed by: