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HANDS ON| Volume 11, ISSUE 2, P330-335, February 2014

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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
Safety and feasibility of transseptal puncture for atrial fibrillation ablation in patients with atrial septal defect closure devices
Previous ArticleAn unusual form of “pacemaker mediated tachycardia”
Next ArticleWPW in conjoined thoracopagus twins
      AF is often found in association with an ASD.
      • Craig R.J.
      • Selzer A.
      Natural history and prognosis of atrial septal defect.
      Circulation. 1968; 37: 805-815
      , 
      • 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.
      Circulation. 1981; 64: 402-409
      , 
      • 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.
      N Engl J Med. 1990; 323: 1645-1650
      , 
      • Spies C.
      • Khandelwal A.
      • Timmermanns I.
      • Schrader R.
      Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults.
      Am J Cardiol. 2008; 102: 902-906
      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.
      Circulation. 1981; 64: 402-409
      , 
      • 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.
      N Engl J Med. 1990; 323: 1645-1650
      , 
      • Spies C.
      • Khandelwal A.
      • Timmermanns I.
      • Schrader R.
      Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults.
      Am J Cardiol. 2008; 102: 902-906
      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.
      Circulation. 2004; 110: 2090-2096
      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.
      J Cardiovasc Electrophysiol. 2008; 19: 1137-1142
      , 
      • 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.
      Heart Rhythm. 2011; 8: 1669-1675
      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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        Natural history and prognosis of atrial septal defect.
        Circulation. 1968; 37: 805-815
        View in Article
        • 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.
        Circulation. 1981; 64: 402-409
        View in Article
        • 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.
        N Engl J Med. 1990; 323: 1645-1650
        View in Article
        • Spies C.
        • Khandelwal A.
        • Timmermanns I.
        • Schrader R.
        Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults.
        Am J Cardiol. 2008; 102: 902-906
        View in Article
        • 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.
        Circulation. 2004; 110: 2090-2096
        View in Article
        • 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.
        J Cardiovasc Electrophysiol. 2008; 19: 1137-1142
        View in Article
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      Article info

      Publication history

      Published online: November 18, 2013

      Footnotes

      Dr Li and Dr Wissner contributed equally to this work.

      Identification

      DOI: https://doi.org/10.1016/j.hrthm.2013.11.011

      Copyright

      © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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