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Right-to-left shunt via iatrogenic atrial septal defect requiring emergency surgical repair following cryoballoon atrial fibrillation ablation in a patient with arrhythmogenic right ventricular cardiomyopathy. J Cardiol Cases 2022; 27:16-18. [PMID: 36618840 PMCID: PMC9808451 DOI: 10.1016/j.jccase.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/15/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
Abstract
An 81-year-old woman with arrhythmogenic right ventricular cardiomyopathy underwent catheter ablation for atrial fibrillation and atrial flutter. Hypoxemia refractory to the administration of oxygen was seen after transseptal puncture. Transthoracic echocardiography revealed right to left shunt via an iatrogenic atrial septal defect (IASD) that was increased by tricuspid regurgitation flow. Her hypoxemia improved after IASD occlusion with the inflation of a venogram balloon catheter. Emergent surgical IASD closure was successfully performed. IASD after transseptal puncture for atrial fibrillation ablation infrequently causes severe complications that require emergent repair. Learning objective Some cases requiring iatrogenic atrial septal defect (IASD) closure after atrial fibrillation (AF) ablation have been reported. We describe the case of an arrhythmogenic right ventricular cardiomyopathy patient with right to left shunt via an IASD which required emergent surgical repair after AF ablation. Right to left shunt after trans-septal puncture is rare, however it can be an emergent life-threatening complication. IASD occlusion with venogram balloon catheter is helpful for the diagnosis and the short-term solution.
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Key Words
- AF, atrial fibrillation
- AFL, atrial flutter
- ARVC, arrhythmogenic right ventricular cardiomyopathy
- Ablation
- Arrhythmogenic right ventricular cardiomyopathy
- Atrial fibrillation
- Cryoballoon
- IASD, iatrogenic atrial septal defect
- Iatrogenic atrial septal defect
- LA, left atrium
- LV, left ventricle
- PVI, Pulmonary vein isolation
- SpO2, systemicoxygen saturation
- TR, tricuspid regurgitation
- TTE, transthoracic echocardiography
- TVP, tricuspid valvuloplasty
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Iatrogenic atrial septal defects after transseptal puncture for percutaneous left atrial appendage occlusion and their hemodynamic effects. J Geriatr Cardiol 2022; 19:675-684. [PMID: 36284683 PMCID: PMC9548059 DOI: 10.11909/j.issn.1671-5411.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Percutaneous left atrial appendage occlusion (LAAO) requires puncture of the interatrial septum. The immediate hemodynamic effects of iatrogenic atrial septal defects (iASD) after LAAO have not been examined so far. We aimed at evaluating these effects through invasive measurements of pressure and oxygen saturation. Moreover, we assessed the incidence of persistent iASD at three months. METHODS Forty-eight patients scheduled for percutaneous LAAO were prospectively included in the study. Pressure and oxygen saturation were measured (1) in the right atrium (RA) before transseptal puncture, (2) in the left atrium (LA) through the transseptal sheath after transseptal puncture, (3) in the LA after removal of introducer sheath, and (4) in the RA after removal of introducer sheath. Transesophageal echocardiography was performed at three months to detect iASD. RESULTS Pressure in the RA increased significantly after removing the introducer sheath (P = 0.034), whereas no difference was found in oxygen saturation in the RA (P = 0.623). Pressure measurement in the LA showed no significant difference after removing the introducer sheath (P = 0.718). Oxygen saturation in the LA also showed no significant difference (P = 0.129). Follow-up transesophageal echocardiogram at 3 months revealed a persistent iASD in 4 patients (8.5 %). CONCLUSIONS Our study suggests that iASD after percutaneous LAAO does not result in significant shunts directly after the procedure, although a significant increase of mean right atrial pressure can be observed. Persistent iASDs after percutaneous LAAO seem to be relatively rare at three months.
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Oates CP, Towheed A, Hadadi CA. Refractory hypoxemia from intracardiac shunting following ventricular tachycardia ablation in a patient with a left ventricular assist device. HeartRhythm Case Rep 2022; 8:760-764. [PMID: 36618602 PMCID: PMC9811018 DOI: 10.1016/j.hrcr.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Connor P. Oates
- Address reprint requests and correspondence: Dr Connor P. Oates, MedStar Georgetown University–Washington Hospital Center, 110 Irving St NW, Washington, DC 20310.
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Heart failure caused by iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation. J Cardiol Cases 2021; 24:303-306. [PMID: 34917216 DOI: 10.1016/j.jccase.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/21/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
An 83-year-old man with no structural heart disease underwent pulmonary vein isolation (PVI) for symptomatic paroxysmal atrial fibrillation (AF). The PVI was successfully performed by cryoballoon ablation with a single transseptal puncture. A 12Fr deflectable sheath and an 8.5Fr long sheath crossed the interatrial septum via the same puncture site. Five months after PVI, the patient was readmitted because of heart failure and recurrence of AF. The echocardiogram showed a large (10.7 × 5.8 mm) iatrogenic atrial septal defect (IASD) at the previous puncture site. Both right-to-left and left-to-right shunts were observed during systole and diastole, respectively. Despite the initiation of optimal medical therapy for heart failure, symptoms were not completely controlled and IASD remained 11 months after PVI. Eventually, he received multiple additional PVI for recurrence of AF and percutaneous transcatheter closure (13 mm disc for 10.9 × 8.9 mm- IASD), then heart failure was controlled with the improvement of the right atrial and ventricular size. Although the induction of heart failure by IASD after PVI is rare, it should be noted as one of the causes, especially after cryoballoon ablation with simultaneous mapping catheter insertion via a single transseptal puncture. <Learning objective: Pulmonary vein isolation (PVI) is the established therapy for atrial fibrillation; however, it may cause several complications including iatrogenic atrial septal defect (IASD). IASD is less apparent than other complications, therefore it may be underrecognized. Although the induction of heart failure by IASD after PVI is rare, it should be noted as one of the causes, especially after cryoballoon ablation with simultaneous circular mapping catheter insertion via a single transseptal puncture.>.
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Nelles D, Vij V, Al-Kassou B, Weber M, Vogelhuber J, Beiert T, Nickenig G, Schrickel JW, Sedaghat A. Incidence, persistence, and clinical relevance of iatrogenic atrial septal defects after percutaneous left atrial appendage occlusion. Echocardiography 2021; 39:65-73. [PMID: 34921426 DOI: 10.1111/echo.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/29/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the rate and clinical impact of a persisting iatrogenic atrial septal defect (iASD) after percutaneous left atrial appendage occlusion (LAAO). BACKGROUND Percutaneous LAAO is an alternative to oral anticoagulation (OAC) for the prevention of ischemic stroke and systemic embolism in patients with atrial fibrillation (AF). Data regarding incidence and persistence of iASD after LAAO procedures and its clinical relevance is scarce. METHODS We retrospectively analyzed 144 patients that underwent LAAO at our center between 2009 and 2020 who had at least one follow-up including transesophageal echocardiography (TEE). Baseline clinical, procedural data and echocardiographic characteristics in patients with and without evidence of an iASD were compared. We furthermore determined the rate of iASD persistence over time and evaluated outcomes of patients with and without spontaneous iASD closure. RESULTS After a median of 92 days (IQR 75-108 days) after LAAO, 50 patients (50/144, 34.7%) showed evidence of an iASD. Patients with iASD had higher CHADS-VASc-scores (4.9±1.5 vs 4.2±1.2, p = 0.03), larger left atrial volumes (80.5±30.5 ml vs 67.1±19.7 ml, p = 0.01) and were more likely to have relevant mitral regurgitation (≥° II) (46.0% vs 12.3%, p = 0.001). LAAO procedures took longer (50.1±24.3 vs 41.1±17.8 min, p = 0.06) in patients with a persisting iASD. Furthermore, larger device sizes were implanted (24.3±3.4 mm vs 22.1±2.8 mm, p = 0.03). The presence of an iASD had no impact on RV dysfunction, thromboembolism or mortality. Spontaneous closure of an iASD was documented in 52.0% (26/50). Hereby, similar risk factors were identified for the persistence of an iASD in follow-up.
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Affiliation(s)
- Dominik Nelles
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | - Vivian Vij
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | | | - Marcel Weber
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | | | - Thomas Beiert
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | - Georg Nickenig
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
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Reddy SA, Nethercott SL, Khialani BV, Virdee MS. Pulmonary vein isolation for atrial fibrillation: Does ablation technique influence outcome? Indian Heart J 2021; 73:718-724. [PMID: 34743897 PMCID: PMC8642637 DOI: 10.1016/j.ihj.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Over the last 20 years various techniques have been developed striving for safer and more durable pulmonary vein isolation (PVI). The three most commonly used tools are pulmonary vein ablation catheter (PVAC) and cryoballoon ('single-shot' techniques), and point-by-point (PBP) radiofrequency ablation using 3D electroanatomical mapping (EAM). OBJECTIVE Evaluate the safety and efficacy of the different techniques in an unselected population undergoing de-novo ablation for persistent or paroxysmal atrial fibrillation (AF) at Royal Papworth Hospital (RPH). METHOD Retrospective, single-centre study of consecutive AF ablations at RPH between March 2017 and April 2018. Demographic, procedural and outcome data were analysed. RESULTS Over the study period 329 first-time PVI procedures were performed. 37.4% were performed using PBP, 39.8% using cryoballoon and 22.8% using PVAC. There was no significant difference in age or sex between different ablation technique groups. 238 procedures were performed for paroxysmal AF and 91 for persistent AF. A higher proportion of the persistent cases were performed using point-by-point techniques compared to paroxysmal cases (58.2% vs 29.0%, p < 0.05). Procedural times were significantly longer in the group undergoing PBP ablation compared to cryoballoon or PVAC. However, there was no statistically significant difference in 12-month freedom from symptomatic AF or procedural complications between the groups. CONCLUSIONS PBP, PVAC and cryoballoon AF ablation all appeared equally efficacious in an unselected population, though PVAC and cryoballoon procedures were shorter. All procedures were associated with a low adverse event rate. Prospective examination is required to substantiate this finding.
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Affiliation(s)
- S A Reddy
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
| | | | - B V Khialani
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
| | - M S Virdee
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
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Aryana A, Su W, Kuniss M, Okishige K, de Asmundis C, Tondo C, Chierchia GB. Segmental nonocclusive cryoballoon ablation of pulmonary veins and extrapulmonary vein structures: Best practices III. Heart Rhythm 2021; 18:1435-1444. [PMID: 33905811 DOI: 10.1016/j.hrthm.2021.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022]
Abstract
Although cryoballoon ablation of atrial fibrillation (AF) traditionally has been guided by pulmonary vein (PV) occlusion, there is evidence and growing interest in performing segmental, nonocclusive cryoballoon ablation to target not only large/common PVs but extra-PV structures such as the left atrial (LA) roof and posterior wall in conjunction with PV isolation. A number of studies have demonstrated improved clinical efficacy associated with nonocclusive cryoballoon ablation of the LA roof and posterior wall in addition to PV isolation, particularly in patients with persistent AF. Not only can the cryoballoon be used for targeting extra-PV structures through segmental, nonocclusive ablation, but the large size and durability of cryolesions coupled with the enhanced stability afforded through cryoadhesion render the cryoballoon an effective tool for such an approach. This article reviews the rationale and practical approach to segmental, nonocclusive cryoballoon ablation of large/common PV antra and the LA roof and posterior wall.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.
| | - Wilber Su
- Banner University Medical Center, Phoenix, Arizona
| | - Malte Kuniss
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | | | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS; Department of Biochemical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Reddy SA, Nethercott SL, Khialani BV, Grace AA, Martin CA. Management of arrhythmias in pulmonary hypertension. J Interv Card Electrophysiol 2021; 62:219-229. [DOI: 10.1007/s10840-021-00988-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022]
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Puga L, Teixeira R, Paiva L, Ribeiro JM, Gameiro J, Sousa JP, Costa M, Gonçalves L. Iatrogenic atrial septal defect after percutaneous left atrial appendage closure: a single-center study. Int J Cardiovasc Imaging 2021; 37:2359-2368. [PMID: 33715110 DOI: 10.1007/s10554-021-02212-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
There is conflicting evidence regarding the significance of iatrogenic atrial septal defects (iASDs) after transseptal puncture during percutaneous cardiac interventions. To study the clinical outcome of iASD after percutaneous left atrial appendage occlusion (LAAo). Single-center, retrospective study of 70 consecutive patients who underwent percutaneous LAAo between May 2010 and August 2017, and subsequent transesophageal echocardiography (TEE) at 1 month. The sample population was divided into two groups: A (with iASD, 22 (37%) patients) and B (no iASD, 44 (63%) patients). Procedures were guided either by TEE (36 patients (54%)) or intracardiac echocardiography (ICE) from the left atrium (30 patients (46%)). The primary end point was presence of iASD at 1 month, and secondary end points included mortality, hospital admission due to heart failure (HF), and right atrium (RA) size during follow-up. 70 patients were included in this study and the prevalence of iASD at 1 month was 37%. The use of ICE was associated with iASD (adjusted odds ratio, 3.79; 95% CI 1.27-11.34). The presence of iASD was not associated with adverse events (mortality, 15.4% vs 20.5%; P = 0.60; HF hospitalizations, 7.7% vs 13.6%, P = 0.45; and RA area, 24.8 ± 7.0 cm2 vs 22.2 ± 6.8 cm2, P = 0.192). At 1-month follow-up after LAAo, iASD was present in one third of patients, but was not associated with clinical outcomes. The use of ICE was associated with a higher risk of short-term iASD.
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Affiliation(s)
- Luís Puga
- Cardiology Department, Centro Hospitalar e universitário de Coimbra - Hospital Geral, Quinta dos Vales - São Martinho do Bispo, 3043-853, Coimbra, Portugal
| | - Rogério Teixeira
- Cardiology Department, Centro Hospitalar e universitário de Coimbra - Hospital Geral, Quinta dos Vales - São Martinho do Bispo, 3043-853, Coimbra, Portugal. .,ICBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Luís Paiva
- Cardiology Department, Centro Hospitalar e universitário de Coimbra - Hospital Geral, Quinta dos Vales - São Martinho do Bispo, 3043-853, Coimbra, Portugal
| | - Joana Maria Ribeiro
- Cardiology Department, Centro Hospitalar e universitário de Coimbra - Hospital Geral, Quinta dos Vales - São Martinho do Bispo, 3043-853, Coimbra, Portugal.,Cardiology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - João Gameiro
- Cardiology Department, Centro Hospitalar e universitário de Coimbra - Hospital Geral, Quinta dos Vales - São Martinho do Bispo, 3043-853, Coimbra, Portugal
| | - José Pedro Sousa
- Cardiology Department, Centro Hospitalar e universitário de Coimbra - Hospital Geral, Quinta dos Vales - São Martinho do Bispo, 3043-853, Coimbra, Portugal
| | - Marco Costa
- Cardiology Department, Centro Hospitalar e universitário de Coimbra - Hospital Geral, Quinta dos Vales - São Martinho do Bispo, 3043-853, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar e universitário de Coimbra - Hospital Geral, Quinta dos Vales - São Martinho do Bispo, 3043-853, Coimbra, Portugal.,ICBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Matar F, Welter-Frost A. Management of Iatrogenic Atrial Septal Defects in the Era of Large-Bore Transcatheter Mitral Valve Therapies. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 31:83-88. [PMID: 33339771 DOI: 10.1016/j.carrev.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/14/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022]
Abstract
Several case reports described acute and subacute decompensations that were reversed after percutaneous interatrial septal defect (ASD) closure. At least 30% of patients post MitraClip will continue to have a persistent ASD at 1 year. Few retrospective studies described various echocardiographic associations with persistent ASD but there is no conclusive evidence that it is the cause of a poor outcome. Conclusion: At this time routine closure of ASD post MitraClip is not recommended unless there is hemodynamic decompensation that cannot be explained by other factors.
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Affiliation(s)
- Fadi Matar
- University of South Florida Morsani College of Medicine, Department of Cardiovascular Sciences, Tampa, FL, United States of America; Tampa General Hospital, Tampa, FL, United States of America.
| | - Allan Welter-Frost
- University of South Florida Morsani College of Medicine, Department of Cardiovascular Sciences, Tampa, FL, United States of America; Tampa General Hospital, Tampa, FL, United States of America
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Mattia A, Newman J, Manetta F. Treatment Complications of Atrial Fibrillation and Their Management. Int J Angiol 2020; 29:98-107. [PMID: 32476810 DOI: 10.1055/s-0039-3401794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Atrial fibrillation (AF) is a rhythm disturbance defined by irregular, rapid electrical, and mechanical activation of the atria, which causes unsynchronized atrial contraction and promotes thromboembolism. AF is the most common sustained arrhythmia. Its prevalence and incidence are increasing due to aging and improved survival from acute heart diseases. This article is a review on AF management from both a surgical and catheter-based perspective. While both treatment approaches to AF have been shown to be successful in the management of AF, they are not without their own inherent complications. This article seeks to review some of these complications and help to guide treatment.
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Affiliation(s)
- Allan Mattia
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Joshua Newman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Frank Manetta
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
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12
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Stauber A, Kornej J, Sepehri Shamloo A, Dinov B, Bacevicius J, Dagres N, Bollmann A, Hindricks G, Sommer P. Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures. Cardiol J 2020; 28:671-677. [PMID: 32207839 DOI: 10.5603/cj.a2020.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/18/2020] [Accepted: 03/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the current study was to analyze the impact of single versus double transseptal puncture (TSP) for atrial fibrillation (AF) ablation. METHODS Consecutive patients undergoing AF ablation were prospectively included in the AF ablation registry and were analyzed according to single versus double TSP. RESULTS A total of 478 patients (female 35%, persistent AF 67%) undergoing AF ablation between 01/2014 and 09/2014 were included. Single TSP was performed in 202 (42%) patients, double TSP in 276 (58%) patients. Age, gender, body mass index, CHA2DS2-VASc score, left ventricular ejection fraction and operator experience (experienced operator defined as ≥ 5 years of experience in invasive electrophysiology) were equally distributed between the two groups. Repeat procedures (re-dos) were more frequently performed using single TSP access (p < 0.001). Left atrial (LA) diameter was larger in patients with double TSP (p = 0.001). Procedure duration in single TSP was identical to double TSP procedures (p = 0.823). Radiation duration was similar between the two groups (p = 0.217). There were 49 (10%) patients with complications after catheter ablation. There were no differences between complication rates and TSP type (p = 0.555). Similarly, recurrence rates were comparable between both TSP groups (p = 0.788). CONCLUSIONS There was no clear benefit of single or double TSP in AF ablation.
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Affiliation(s)
- Annina Stauber
- Department of Electrophysiology, Heart Center University Leipzig, Germany.
| | - Jelena Kornej
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | | | - Boris Dinov
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center University Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center University Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany.,Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum, Bad Oeynhausen, Germany
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Prospective evaluation of iatrogenic atrial septal defect after cryoballoon or radiofrequency catheter ablation of atrial fibrillation-"EVITA" study. J Interv Card Electrophysiol 2019; 56:19-27. [PMID: 31399921 DOI: 10.1007/s10840-019-00598-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Iatrogenic atrial septal defect (IASD) after catheter ablation (CA) for atrial fibrillation (AF) due to transseptal puncture (TSP) can occur. The aim of this prospective study was to describe the incidence of IASD and to detect any cerebrovascular accident (CVA) after radiofrequency (RF) and cryoballoon (CB) CA. METHODS Between July 2014 and September 2016, 94 patients (pts) (RF; 48, CB; 46, 30 (31.9%) women, mean age = 60 ± 9.7 years) with paroxysmal AF were enrolled who underwent CA procedure for the first time. During RF ablation a single (n = 30, 62.5%) or double (n = 18, 37.5%) TSP was performed. Transoesophageal echocardiography before the procedure and at the 3-month and 12-month follow-up (FU) was accomplished. During the FU period, we evaluated the occurrence of any postprocedural CVA. RESULTS At the 3-month FU, IASD was detected in 17/94 (18.1%) pts; in 9/48 (18.8%) pts in the RF while in 8/46 (17.4%) pts in the CB group (p = 0.866), all of them with left-to-right shunt. In the RF group, 6/30 (20%) pts with a single TSP while 3/18 (16.7%) pts in the double TSP group had IASD (p = 0.780). 14/17 (82.4%) IASDs showed high spontaneous closure rate at the 12-month FU. None of the pts died or suffered from CVA. CONCLUSION Persistent IASD can occur rather frequently following AF CA. No significant difference was observed between the RF and CB techniques concerning the presence of IASD at 3-month. IASDs showed a high spontaneous closure rate. No cerebral thromboembolic event was observed in the 12-month FU period.
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14
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Hong KL, Glover BM. Iatrogenic Atrial Septal Defects After Transseptal Access for Atrial Fibrillation Ablations. Can J Cardiol 2019; 35:368-369. [PMID: 30935624 DOI: 10.1016/j.cjca.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Kathryn L Hong
- Schulich Heart Center, Sunnybrook Hospital, University of Toronto, Ontario, Canada
| | - Benedict M Glover
- Schulich Heart Center, Sunnybrook Hospital, University of Toronto, Ontario, Canada.
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15
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Chan NY, Choy CC, Yuen HC, Chow HF, Fong HF. A Very Long-term Longitudinal Study on the Evolution and Clinical Outcomes of Persistent Iatrogenic Atrial Septal Defect After Cryoballoon Ablation. Can J Cardiol 2019; 35:396-404. [DOI: 10.1016/j.cjca.2018.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/15/2018] [Accepted: 12/15/2018] [Indexed: 11/15/2022] Open
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16
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Eshcol J, Wimmer AP. Hemodynamically significant iatrogenic atrial septal defects after cryoballoon ablation. HeartRhythm Case Rep 2018; 5:17-21. [PMID: 30693199 PMCID: PMC6342334 DOI: 10.1016/j.hrcr.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jayasheel Eshcol
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Alan P Wimmer
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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Blockhaus C, Waibler HP, Gülker JE, Klues H, Bufe A, Shin DI. Evasion maneuver for transseptal approach during cryoballoon pulmonary vein isolation. J Saudi Heart Assoc 2018; 30:301-304. [PMID: 30069135 PMCID: PMC6067055 DOI: 10.1016/j.jsha.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/11/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose Pulmonary vein isolation (PVI) is a cornerstone therapy in patients with symptomatic atrial fibrillation. One current method is performing a PVI using a cryoballoon (CB). The CB is inserted into the left atrium via a steerable sheath. However, at times, passing of the interatrial septum by the sheath is hindered, e.g., due to septal fibrosis. Here we report our experience with an evasion maneuver to facilitate this approach using a 6F multipolar and steerable coronary Sinus catheter (CS) for predilatation of the interatrial septum. Methods and results We report 10 patients undergoing a CB-PVI, where the investigator experienced difficulties in passing the interatrial septum with the CB sheath. In these cases, after three conventional abortive attempts, we predilated the transseptal puncture site using both the CS catheter and the dilatator of the CB sheath. Thereafter access of the CB sheath to the left atrium could be achieved instantly and without further resistance. Conclusion We report a safe and feasible maneuver to facilitate transseptal access with the CB steerable sheath in cases complicated by excessive interatrial resistance.
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Affiliation(s)
- Christian Blockhaus
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
- Corresponding author at: Department of Cardiology, Heart Centre Niederrhein, Helios Clinics, Lutherplatz 40, 47805 Krefeld, Germany.
| | - Hans-Peter Waibler
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
| | - Jan-Erik Gülker
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
| | - Heinrich Klues
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
| | - Alexander Bufe
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
- University Witten/Herdecke, Witten, Germany
| | - Dong-In Shin
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
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Naksuk N, Asirvatham SJ. Iatrogenic atrial septal defect: reassurance or inquisitiveness. J Interv Card Electrophysiol 2018; 52:137-140. [DOI: 10.1007/s10840-018-0369-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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