Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo

Abstract

INTERATRIAL SEPTAL DISORDERS, WHICH INCLUDE: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Interatrial septal anomalies were detected in around 85% of the examined patients. Patent foramen ovale was encountered in 32% of the patients, and in combination with atrial septal aneurysm in an additional 11.3% of cases. Atrial septal aneurysm and atrial septal defect were diagnosed with equal frequency in 20.7% of our study population. Impulse conduction disorders were significantly more suggestive of interatrial septal anomalies than clinical signs and symptoms observed in our patients (84.91% vs 30.19%, P=0.002). Right bundle branch block was the most frequent impulse conduction disorder, found in 41 (77.36%) cases. We conclude that interatrial septal anomalies are highly associated with impulse conduction disorders, particularly with right bundle branch block. Impulse conduction disorders are more indicative of interatrial septal abnormalities in earlier stages than can be understood from the patient's clinical condition.

Keywords: atrial septal aneurysm; atrial septal defect; patent foramen ovale; right bundle branch block..

Figure 1

TEE images of interatrial septal abnormalities. (A) PFO in a 30-year old patient with ECG signs of RBBB. (B) ASA type 1R associated with PFO (demonstrated with color-doppler) in a 40-year old patient with RBBB. (C) A large ASD ostium secundum type in a 38-year old patient with RBBB. (D) A partial atrio-ventricular canal in a 55-year old patient with ECG signs of LBBB, with absence of entire interatrial septum and incompetent mitral and tricuspid valves resulting in massive regurgitation.

Figure 2

Association of impulse conduction disorders and interatrial septal abnormalities.

Figure 3

Association of clinical staging and interatrial septal abnormalities.