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Images and Case Reports in Arrhythmia and Electrophysiology

Delayed Heart Block After Temporary Balloon Occlusion of a Secundum Atrial Septal Defect

Sheldon M. Singh, MD and Saumya Das, MD, PhD

From the Massachusetts General Hospital, Boston, Mass.

Correspondence to Saumya Das, MD, Massachusetts General Hospital, GRB 109, 55 Fruit Street, Boston, MA 02114. E-mail sdas@partners.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Although the association between atrial arrhythmias and atrial septal defects (ASD) has been well described, abnormalities of AV nodal conduction, typically in the setting of ASD device closure, have been infrequently reported.^1–4 We report a case of transient complete heart block several hours after temporary balloon occlusion of a secundum ASD. To our knowledge, this is the first report describing delayed complete heart block with temporary balloon occlusion of an ASD.

A 35-year-old woman with Eisenmenger’s syndrome secondary to a secundum ASD and anomalous pulmonary venous drainage was hospitalized with a Hickman line infection. The decision was made to remove the line, given the presence of vegetations and septic pulmonary emboli. To avoid systemic vegetation embolization, temporary occlusion of the ASD at the time of the line removal was planned. The patient had no prior history of heart block and a normal PR interval on a baseline ECG (Figure, panel A).

View larger version (133K):   Figure. A, Baseline ECG. B, Balloon occlusion of atrial septal defect. C, High-grade AV block 18 hours after balloon occlusion of atrial septal defect.

 
A 34-mm Amplatzer balloon was placed across the ASD and inflated (waist diameter 16 mm) to occlude flow between the right and left atria (panel B). The balloon remained inflated for 25 minutes during manipulation and removal of the Hickman line. No intraprocedural hemodynamic or conduction abnormalities were noted. Eighteen hours after the procedure the patient experienced syncope with documented high-grade AV block (panel C). The episode persisted for 3 minutes with spontaneous . . . [Full Text of this Article]