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Safety and feasibility of transseptal puncture for atrial fibrillation ablation in patients with atrial septal defect closure devices

Published:November 18, 2013DOI:https://doi.org/10.1016/j.hrthm.2013.11.011
      AF is often found in association with an ASD.
      • Craig R.J.
      • Selzer A.
      Natural history and prognosis of atrial septal defect.
      • John Sutton M.G.
      • Tajik A.J.
      • McGoon D.C.
      Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up.
      • Murphy J.G.
      • Gersh B.J.
      • McGoon M.D.
      • et al.
      Long-term outcome after surgical repair of isolated atrial septal defect: follow-up at 27 to 32 years.
      • Spies C.
      • Khandelwal A.
      • Timmermanns I.
      • Schrader R.
      Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults.
      There are an increasing number of patients undergoing transcatheter closure of an ASD who subsequently develop AF in clinical practice.
      • John Sutton M.G.
      • Tajik A.J.
      • McGoon D.C.
      Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up.
      • Murphy J.G.
      • Gersh B.J.
      • McGoon M.D.
      • et al.
      Long-term outcome after surgical repair of isolated atrial septal defect: follow-up at 27 to 32 years.
      • Spies C.
      • Khandelwal A.
      • Timmermanns I.
      • Schrader R.
      Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults.
      Catheter ablation has emerged as an effective treatment strategy for drug-refractory symptomatic AF.
      • Ouyang F.
      • Bansch D.
      • Ernst S.
      • et al.
      Complete isolation of left atrium surrounding the pulmonary veins: new insights from the double-Lasso technique in paroxysmal atrial fibrillation.
      While transseptal access to the left atrium (LA) is a prerequisite for AF ablation, it may prove difficult in the presence of an ASD closure device.
      • Lakkireddy D.
      • Rangisetty U.
      • Prasad S.
      • et al.
      Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair: a feasibility, safety, and efficacy study.
      • Santangeli P.
      • Di Biase L.
      • Burkhardt J.D.
      • et al.
      Transseptal access and atrial fibrillation ablation guided by intracardiac echocardiography in patients with atrial septal closure devices.
      Anticipating technical difficulties and potential complications may discourage operators from considering catheter ablation of AF in this particular patient population. Herein, we describe our experience with TSP in patients with prior implantation of an ASD closure device.

      Abbreviations:

      AF (atrial fibrillation), ASD (atrial septal defect), ICE (intracardiac echocardiography), LA (left atrium/atrial), PCI (percutaneous coronary intervention), PV (pulmonary vein), PVI (pulmonary vein isolation), TSP (transseptal puncture)

      Keywords

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