# Comparison of atrial arrhythmias and autonomic function parameters according to atrial septal defect closure techniques

## TL;DR

This study compares how surgical and transcatheter closure of atrial septal defects affect arrhythmias and autonomic function in children.

## Contribution

The study provides a direct comparison of arrhythmia and autonomic outcomes between surgical and transcatheter ASD closure techniques in pediatric patients.

## Key findings

- Surgical ASD closure was associated with higher supraventricular premature beats and reduced heart rate variability.
- Transcatheter closure showed autonomic function comparable to healthy controls, unlike surgical closure.
- P-wave dispersion and sympathetic dominance were more pronounced after surgical repair.

## Abstract

Atrial septal defects (ASDs) are associated with an increased risk of atrial arrhythmias due to right atrial dilation, electrical remodeling, and conduction abnormalities. In addition to arrhythmias, autonomic dysfunction may also occur. Although several studies have investigated the impact of transcatheter ASD closure on arrhythmia risk in pediatric patients, direct comparative analyses between surgical and transcatheter closure techniques remain limited in the current literature.

This study included patients who underwent ASD closure via surgical or transcatheter methods before age 18 and had at least 12 months of follow-up. A control group of healthy, age- and sex-matched children without cardiac disease was also included. All participants underwent 12-lead electrocardiography (ECG) and 24 h Holter monitoring. Patient data included arrhythmia symptoms, closure method, age at closure, defect size, and catheterization findings. Individuals with other cardiac anomalies, genetic syndromes, or medications affecting conduction were excluded.

The study included 131 participants: 91 ASD patients (56 surgical, 35 transcatheter) and 40 controls. Supraventricular premature beats (SVPB) was significantly more frequent in both intervention groups compared to controls, with the highest frequency in the surgical group (p < 0.001). P-wave dispersion was also highest in the surgical group. In the surgical group, Lowns grade correlated positively with Qp/Qs, mean pulmonary artery pressure, and follow-up duration. Heart rate variability (HRV) parameters were significantly lower in the surgical group, indicating sympathetic dominance.

Atrial septal defect repair increases atrial arrhythmia risk, particularly following surgical intervention. While autonomic function remained comparable to controls after transcatheter closure, surgical closure was associated with reduced HRV and increased sympathetic activity.