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      Is There an Association of Atrial Septal Aneurysm with Arrhythmias?

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          Abstract

          An association of atrial septal aneurysm (ASA) with cardiac arrhythmias has been described, and it has been suggested that undulating movements of the aneurysm initiate these arrhythmias, thereby causing arterial embolism. In this prospective study, all available electrocardiograms were reviewed and Holter monitoring was performed in 50 consecutive patients with echocardiographic diagnosis of ASA in order to assess the relationship between the occurrence of arrhythmias, morphologic characteristics of ASA and arterial embolism. Significant arrhythmias were identified in 26 (52%) patients (supraventricular n = 15, ventricular n = 6, both n= 5). Patients with arrhythmias were older (65 ± 12 vs. 54 ± 13 years, p = 0.005), frequently had palpitations (21/26 vs. 1/24, p < 0.0001) and an abnormal resting electrocardiogram (18/26 vs. 5/24, p < 0.001). By echocardiography, patients with arrhythmias had a larger left atrial (42.8 ± 7.4 vs. 35.3 ± 4.6 mm, p < 0.0001) and left ventricular enddiastolic diameter (53.8 ± 5.6 vs. 49.7 ± 4.1, p < 0.01) and a higher prevalence of associated mitral valve prolapse (12/26 vs. 4/24, p = 0.05). Potential cardiovascular causes for arrhythmia other than ASA were present in the great majority of patients with documented arrhythmias (24/26 vs. 7/24, p < 0.0001). The base diameter of ASA was larger in patients with arrhythmias (25.5 ± 6.2 vs. 21.4 ± 3.4, p < 0.01) and correlated with a larger left atrial diameter (r = 0.72, p < 0.0001). Concerning the mobility of ASA (maximal protrusion or phasic excursion), there was no significant difference between the two patient groups. Arterial embolism, however, predominantly occurred in ASA patients without arrhythmias (16/24 vs. 9/26, p < 0.05). In conclusion, the majority of patients with ASA and arrhythmias has underlying structural heart disease other than ASA which may be responsible for the arrhythmias observed. Arrhythmias in association with ASA do not play a major role as a mechanism for arterial embolism.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          1999
          August 1999
          06 August 1999
          : 91
          : 2
          : 87-91
          Affiliations
          II. Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany
          Article
          6885 Cardiology 1999;91:87–91
          10.1159/000006885
          10449878
          © 1999 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Tables: 2, References: 30, Pages: 5
          Categories
          General Cardiology

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