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Published in: Journal of Interventional Cardiac Electrophysiology 3/2008

01-09-2008

Persistent iatrogenic atrial septal defect after pulmonary vein isolation

Incidence and clinical implications

Authors: Andreas Rillig, Udo Meyerfeldt, Ralf Birkemeyer, Fabian Treusch, Markus Kunze, Werner Jung

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2008

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Abstract

Introduction

Pulmonary vein isolation (PVI) is widely practiced for treating atrial fibrillation. Transseptal access is necessary with one or even more transseptal sheaths to perform PVI.

Methods

In this prospective study, 31 patients were examined with transesophageal echocardiography before, immediately after and in a 3-, 6- and 12-month follow-up period for evaluation of iatrogenic atrial septal defect (iASD). All patients underwent PVI with double transseptal puncture.

Results

An iASD was detected in 27/31 patients (87%) with a maximum diameter of 1.0 mm. After 3 months, the iASDs were completely closed in 26/27 (96.3%) patients. In 1/27 (3.7%) patients, there was an iASD detectable even after 12 months. Clinically no patient suffered from cerebral or cardiac embolism in the follow-up period.

Conclusions

We were only able to find small iASDs with left to right shunting after PVI but none with right to left shunting. iASDs following PVI show a high spontaneous closure rate already at 3 months of follow-up and are not associated with an increased rate of paradoxical embolism.
Literature
1.
go back to reference Lin, W. S., Tai, C. T., Hsieh, M. H., et al. (2003). Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation, 107, 3176–3183.PubMedCrossRef Lin, W. S., Tai, C. T., Hsieh, M. H., et al. (2003). Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation, 107, 3176–3183.PubMedCrossRef
2.
go back to reference Pappone, C., Augello, G., Sala, S., et al. (2006). A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: The APAF (Ablation for Paroxysmal Atrial Fibrillation) Study. Journal of the American College of Cardiology, 48, 2340–2347.PubMedCrossRef Pappone, C., Augello, G., Sala, S., et al. (2006). A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: The APAF (Ablation for Paroxysmal Atrial Fibrillation) Study. Journal of the American College of Cardiology, 48, 2340–2347.PubMedCrossRef
3.
go back to reference Haïssaguerre, M., Hocini, M., Sanders, P., et al. (2005). Catheter ablation of long-lasting persistent atrial fibrillation: Clinical outcome and mechanisms of subsequent arrhythmias. Journal of Cardiovascular Electrophysiology, 16, 1138–1147.PubMedCrossRef Haïssaguerre, M., Hocini, M., Sanders, P., et al. (2005). Catheter ablation of long-lasting persistent atrial fibrillation: Clinical outcome and mechanisms of subsequent arrhythmias. Journal of Cardiovascular Electrophysiology, 16, 1138–1147.PubMedCrossRef
4.
go back to reference Oral, H., Pappone, C., Chugh, A., et al. (2006). Circumferential pulmonary-vein ablation for chronic atrial fibrillation. New England Journal of Medicine, 354, 934–941.PubMedCrossRef Oral, H., Pappone, C., Chugh, A., et al. (2006). Circumferential pulmonary-vein ablation for chronic atrial fibrillation. New England Journal of Medicine, 354, 934–941.PubMedCrossRef
5.
go back to reference Fuster, V., Ryden, L. E., Cannom, D. S., et al. (2006). American College of Cardiology/American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation, 114, e257–e354.PubMedCrossRef Fuster, V., Ryden, L. E., Cannom, D. S., et al. (2006). American College of Cardiology/American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation, 114, e257–e354.PubMedCrossRef
6.
go back to reference O’Neill, M. D., Jaïs, P., Hocini, M., et al. (2007). Catheter Ablation for Atrial Fibrillation. Circulation, 116, 1515–1523.PubMedCrossRef O’Neill, M. D., Jaïs, P., Hocini, M., et al. (2007). Catheter Ablation for Atrial Fibrillation. Circulation, 116, 1515–1523.PubMedCrossRef
7.
go back to reference Haissaguerre, M., Jais, P., Shah, D. C., et al. (2000). Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiplepulmonary venous foci. Circulation, 101, 1409–1417.PubMed Haissaguerre, M., Jais, P., Shah, D. C., et al. (2000). Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiplepulmonary venous foci. Circulation, 101, 1409–1417.PubMed
8.
go back to reference Cappato, R., Calkins, H., Chen, S. A., et al. (2005). Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation, 111, 1100–1105.PubMedCrossRef Cappato, R., Calkins, H., Chen, S. A., et al. (2005). Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation, 111, 1100–1105.PubMedCrossRef
9.
go back to reference Hammerstingl, C., Lickfett, L., Jeong, K. M., Troatz, C., Wedekind, J. A., Tiemann, K., et al. (2006). Persistence of iatrogenic atrial septal defect after pulmonary vein isolation—An underestimated risk? American Heart Journal, 152(2), 362.e1–362.e5.CrossRef Hammerstingl, C., Lickfett, L., Jeong, K. M., Troatz, C., Wedekind, J. A., Tiemann, K., et al. (2006). Persistence of iatrogenic atrial septal defect after pulmonary vein isolation—An underestimated risk? American Heart Journal, 152(2), 362.e1–362.e5.CrossRef
10.
go back to reference Sakata, Y., & Feldman, T. (2005). Transcatheter creation of atrial septal perforation using a radiofrequency transseptal system: Novel approach as an alternative to transseptal needle puncture. Catheterization and Cardiovascular Interventions, 64, 327–332.PubMedCrossRef Sakata, Y., & Feldman, T. (2005). Transcatheter creation of atrial septal perforation using a radiofrequency transseptal system: Novel approach as an alternative to transseptal needle puncture. Catheterization and Cardiovascular Interventions, 64, 327–332.PubMedCrossRef
11.
go back to reference Justino, H., Benson, L. N., & Nykanen, D. G. (2001). Transcatheter creation of an atrial septal defect using radiofrequency perforation. Catheterization and Cardiovascular Interventions, 54, 83–87.PubMedCrossRef Justino, H., Benson, L. N., & Nykanen, D. G. (2001). Transcatheter creation of an atrial septal defect using radiofrequency perforation. Catheterization and Cardiovascular Interventions, 54, 83–87.PubMedCrossRef
12.
go back to reference Krishnamoorthy, K. M., & Dash, P. K. (2001). Transseptal catheterization without needle puncture. Scandinavian Cardiovascular Journal, 35, 199–200.PubMedCrossRef Krishnamoorthy, K. M., & Dash, P. K. (2001). Transseptal catheterization without needle puncture. Scandinavian Cardiovascular Journal, 35, 199–200.PubMedCrossRef
13.
go back to reference De Ponti, R., Cappato, R., Curnis, A., et al. (2006). Trans-septal catheterization in the electrophysiology laboratory: Data from a multicenter survey spanning 12 years. Journal of the American College of Cardiology, 47, 1037–1042.PubMedCrossRef De Ponti, R., Cappato, R., Curnis, A., et al. (2006). Trans-septal catheterization in the electrophysiology laboratory: Data from a multicenter survey spanning 12 years. Journal of the American College of Cardiology, 47, 1037–1042.PubMedCrossRef
14.
go back to reference Obel, O., Mansour, M., Picard, M., Ruskin, J., & Keane, D. (2004). Persistence of septal defects after transeptal puncture for pulmonary vein isolation procedures. Pacing and Clinical Electrophysiology, 27, 1411–1414.PubMedCrossRef Obel, O., Mansour, M., Picard, M., Ruskin, J., & Keane, D. (2004). Persistence of septal defects after transeptal puncture for pulmonary vein isolation procedures. Pacing and Clinical Electrophysiology, 27, 1411–1414.PubMedCrossRef
15.
16.
go back to reference Lechat, P., Mas, J. L., Lascault, G., et al. (1988). Prevalence of patent foramen ovale in patients with stroke. New England Journal of Medicine, 318, 1148–1152.PubMed Lechat, P., Mas, J. L., Lascault, G., et al. (1988). Prevalence of patent foramen ovale in patients with stroke. New England Journal of Medicine, 318, 1148–1152.PubMed
17.
go back to reference Lickfett, L., Hackenbroch, M., Lewalter, T., et al. (2006). Cerebral diffusion-weighted magnetic resonance imaging: A tool to monitor the thrombogenicity of left atrial catheter ablation. Journal of Cardiovascular Electrophysiology, 17, 1–7.PubMed Lickfett, L., Hackenbroch, M., Lewalter, T., et al. (2006). Cerebral diffusion-weighted magnetic resonance imaging: A tool to monitor the thrombogenicity of left atrial catheter ablation. Journal of Cardiovascular Electrophysiology, 17, 1–7.PubMed
18.
go back to reference Yoshida, K., Yoshikawa, J., Akasaka, T., et al. (1989). Assessment of left-to-right atrial shunting after percutaneous mitral valvuloplasty by transesophageal color Doppler flow-mapping. Circulation, 80, 1521–1526.PubMed Yoshida, K., Yoshikawa, J., Akasaka, T., et al. (1989). Assessment of left-to-right atrial shunting after percutaneous mitral valvuloplasty by transesophageal color Doppler flow-mapping. Circulation, 80, 1521–1526.PubMed
19.
go back to reference Gibo, H., Carver, C. C., Rhoton, A. L., Jr., Lenkey, C., & Mitchell, R. J. (1981). Microsurgical anatomy of the middle cerebral artery. Journal of Neurosurgery, 54, 151–169.PubMedCrossRef Gibo, H., Carver, C. C., Rhoton, A. L., Jr., Lenkey, C., & Mitchell, R. J. (1981). Microsurgical anatomy of the middle cerebral artery. Journal of Neurosurgery, 54, 151–169.PubMedCrossRef
20.
go back to reference Azarbal, B., Tobis, J., Suh, W., Chan, V., Dao, C., & Gaster, R. (2005). Association of interatrial shunts and migraine headaches: Impact of transcatheter closure. Journal of the American College of Cardiology, 45(4), 489–492.PubMedCrossRef Azarbal, B., Tobis, J., Suh, W., Chan, V., Dao, C., & Gaster, R. (2005). Association of interatrial shunts and migraine headaches: Impact of transcatheter closure. Journal of the American College of Cardiology, 45(4), 489–492.PubMedCrossRef
Metadata
Title
Persistent iatrogenic atrial septal defect after pulmonary vein isolation
Incidence and clinical implications
Authors
Andreas Rillig
Udo Meyerfeldt
Ralf Birkemeyer
Fabian Treusch
Markus Kunze
Werner Jung
Publication date
01-09-2008
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 3/2008
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-008-9257-7

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