Hands On
Safety and feasibility of transseptal puncture for atrial fibrillation ablation in patients with atrial septal defect closure devices
AF is often found in association with an ASD.1–4 There are an increasing number of patients undergoing transcatheter closure of an ASD who subsequently develop AF in clinical practice.2–4 Catheter ablation has emerged as an effective treatment strategy for drug-refractory symptomatic AF.5 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.6,7 Anticipating technical difficulties and potential complications may discourage operators from considering catheter ablation of AF in this particular patient population.How to determine and assess endpoints for left atrial ablation
Studies have demonstrated that myocardium surrounding pulmonary vein (PV) ostia plays an important role in the initiation and perpetuation of atrial fibrillation (AF).1,2 This important finding has led to the development of segmental PV ostial isolation, circumferential ablation, and isolation around the PVs using circular linear lesions guided by three-dimensional (3D) electroanatomic mapping. Substrate modification using limited linear ablation also has been demonstrated to improve the clinical outcome after PV isolation in patients with AF inducibility.
