Background

Atrial arrhythmias are well-known complications of atrial septal defect (ASD), and associated with substantial morbidity. After ASD closure, right atrial and ventricular enlargement regresses, however, the risk of atrial arrhythmia development continues. In this study, we aimed to investigate the relationship between the Crochetage sign, which is a possible reflection of heterogeneous ventricular depolarization due to long-term hemodynamic overload, and the development of late atrial arrhythmia after ASD closure.

Methods

This retrospective study included a total of 314 patients (mean age: 39.5 (30–50) years; male: 115) who underwent percutaneous device closure for secundum ASD. The study population was divided into two groups according to the presence or absence of the Crochetage sign. The Crochetage sign was defined as an M-shaped or bifid pattern notch on the R wave in one or more inferior limb leads. Cox-regression analysis was performed to determine independent predictors of late atrial arrhythmia development.

Result

Fifty-seven patients (18.1%) presented with late atrial arrhythmia. Of these 57 patients, 30 developed new-onset atrial fibrillation/atrial flutter (AF/AFL), and 27 patients with pre-procedure paroxysmal AF/AFL had a recurrence of AF/AFL during follow-up. History of paroxysmal AF/AFL before the procedure (HR: 4.78; 95% CI 2,52–9.05; p < 0.001), the presence of Crochetage sign (HR: 3.90; 95% CI 2.05–7.76; p < 0.001), and older age at the time of ASD closure (HR: 1.03; 95% CI 1.01–1.06; p = 0.002) were found as independent predictors for late atrial arrhythmia.

Conclusion

The presence of Crochetage sign may be used to predict the risk of late atrial arrhythmia development after transcatheter ASD closure.

中文翻译：

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钩针标志可预测接受经导管封堵术的继发孔型房间隔缺损患者的晚期房性心律失常

背景

房性心律失常是众所周知的房间隔缺损 (ASD) 并发症，并且与大量发病率相关。ASD 关闭后，右心房和心室扩大消退，但房性心律失常发展的风险仍在继续。在本研究中，我们旨在调查钩针征（可能反映长期血流动力学超负荷引起的心室异质性去极化）与 ASD 闭合后晚期房性心律失常发展之间的关系。

方法

这项回顾性研究共纳入了 314 名因继发性 ASD 接受经皮装置封堵术的患者（平均年龄：39.5 (30-50) 岁；男性：115）。研究人群根据钩针符号的存在或不存在分为两组。Crochetage 征被定义为一个或多个下肢导联的 R 波上的 M 形或双歧模式凹痕。进行 Cox 回归分析以确定晚期房性心律失常发展的独立预测因素。

结果

57 名患者 (18.1%) 出现晚期房性心律失常。在这 57 名患者中，30 名出现新发房颤/心房扑动 (AF/AFL)，27 名术前阵发性 AF/AFL 患者在随访期间出现 AF/AFL 复发。手术前阵发性 AF/AFL 病史（HR：4.78；95% CI 2,52–9.05；p < 0.001），存在钩针符号（HR：3.90；95% CI 2.05–7.76；p < 0.001），发现 ASD 闭合时年龄较大（HR：1.03；95% CI 1.01–1.06；p = 0.002）是晚期房性心律失常的独立预测因素。

结论

Crochetage 标志的存在可用于预测经导管 ASD 闭合后发生晚期房性心律失常的风险。