Effect Of Interventional Occlusion Of Adults Secundum ASD On Cardiac Electrophysiology And Aviation Adaptability Of Pilots

Secundum atrial septal defect(ASD)is the most common type of left-to-right shunt heart defect.Long-term shunt will enlarge the heart,overstretch the atrium and lead to structural remodeling.Interventional occlusion is helpful to reverse cardiac structural remodeling and change electrophysiological activity,so as to prevent the occurrence of atrial arrhythmias,which is of clinical significance to both ordinary people and the pilots.In this study,the changes of Pmax and Pd in patients with ASD before and after interventional occlusion were compared to evaluate the effect of interventional occlusion on electrophysiological activity,and to explore the aviation adaptability of pilot with ASD.The study included 41 patients with secundum ASD treated in the Air Force Medical Center from September 2010 to September 2020 and 41 cases in the control group.The two groups were divided into group A(≤ 40 years old)and group B(>40 years old)according to their age,respectively.There were 10 pilots in the patient group,and then called the pilot group.The basic conditions(including age,sex,body weight,symptoms and signs,medication and arrhythmia)were compared between the control group and the patient group before closure,and the types of aircraft,flight time and the aeromedical identification of the pilot group were counted.The pilots were followed up for flight time and safety after aeromedical identification(the follow-up deadline was the end of December 2020).The changes of ECG parameters and cardiac function indexes were observed before closure,1 day after closure and the control group,such as P wave maximum duration(Pmax),P wave minimum duration(Pmin),P wave dispersion(Pd),PR interval,the amplitude of P wave in lead II,QRS duration,corrected QT interval,amplitude of R wave in lead V5(RV5)and amplitude of S wave in lead V1(SV1)and their ratio(RV5/SV1),EF,FS.At the same time,the changes of ECG parameters and cardiac function indexes in the pilot group were observed before closure,1 day and 6 months after closure,and the aviation adaptability of pilots after ASD interventional occlusion was discussed.It was found that there was no significant difference in age,sex and body weight between the patient group and the control group,but there was significant difference in murmur,arrhythmia and medication between the patient group and the control group(P<0.01,P<0.01,P<0.05).The Pmax,Pd,PR interval,QRS duration,RV5/SV1 in the patient group before closure were higher than those in the control group,while SV1 was lower than that in the control group,and the difference was statistically significant(P<0.01).The average heart rate,P wave amplitude,Pmax,Pd and QRS duration in the patient group after closure were lower than those before closure,and the ratio of QT/QTc was higher than that before closure,and the difference was statistically significant(P<0.05).The levels of Pmax and Pd in patient A before operation were higher than those in control A(P< 0.01),and Pmax in patient A after closure was significantly lower than that in patient A before operation(P<0.01).Among the 10 pilots,9 pilots were qualified 6 months after closure,and 1 case was grounded because of congenital fibrinogen deficiency.Pmax and Pd are significantly increased in patients with ASD.Interventional occlusion is helpful to improve atrial remodeling,restore normal electrophysiological activity and prevent the occurrence of atrial arrhythmias.Pilots with ASD can be considered to be qualified if there are no complications affecting flight after interventional occlusion,but sufficient clinical evidence and data support are needed,combining with the types of aircraft,flight duties,flight experience and personal wishes.