(CCSP025) LESS LONG-TERM MIGRAINE IN CHILDREN FOLLOWING OCCLUTECH PERCUTANEOUS ATRIAL SEPTAL DEFECT CLOSURE VS THE AMPLATZ

Background: Percutaneous closure of secundum atrial septal defect (ASD) is associated with an exacerbation of pre-existing migraine symptoms and the onset of de novo migraines that normally resolve within 3 months after the procedure. Few studies address the possible persistence of long-term symptoms, particularly in the pediatric population and none compares the occluding device used. At the CHU Ste-Justine, ASD closure is exclusively percutaneous, using either Amplatz or Occlutech occluders. Our study aims to evaluate the prevalence of long-term migraines in the pediatric population after secundum ASD closure, while comparing based on the implanted device.

METHODS AND RESULTS: We conducted a cross-sectional study evaluating the prevalence of migraine in the pediatric population beyond the 3 months following ASD closure, and compared results based on the device used. A retrospective chart review was performed followed by a telephone interview with parents/patients according to a standardized script. The MIDAS questionnaire for headache-related disability in the 3 preceding months was used. Our population (n=212) includes all patients who underwent ASD closure between 2010 and 2020 at the CHU Sainte-Justine. Telephone questionnaire was completed with 72 patients (42 Amplatz and 30 Occlutech). A family history of migraine was reported in 39 patients (21 Amplatz vs 18 Occlutech, p=0.401), and 12 had personal history of headaches preceding the intervention (9 Amplatz vs 3 Occlutech, p=0.120) or exacerbation of migraine headaches (4 Amplatz vs 3 Occlutech p=0.419) in the 3 months following the procedure (Fig. 1). Among the 58 patients (31 Amplatz, 27 Occlutech) without headaches before the intervention, 18 (31%) developed headaches within 3 months post intervention (9 Amplatz vs 9 Occlutech p=0.798) (Fig. 1). Finally, long-term migraine was reported by 32% of patients, with a significantly lower long-term migraine prevalence reported by patients who received Occlutech (13%) versus Amplatz (38%) device, (p=0.021) (Fig. 2). There was no significant difference in average device size (20mm Amplatz vs 18mm Occlutech p=0.152) or Qp/Qs (1.95 Amplatz vs 1.68 Occlutech p=0.074) neither between the two device-groups, nor between patients with or without long-term migraines (device size 21mm vs 19mm (p=0.229) and Qp/Qs 1.77 vs 1.88 (p=0.452)).

Conclusion: Our results suggest a considerable long-term prevalence of migraine post percutaneous ASD closure. Despite comparable baseline personal and family migraine history and despite acute post-procedural onset headaches, a significant difference in long-term migraine was more favorable to those patients who received an Occlutech device, unrelated to ASD/device size or Qp/Qs magnitude.