Zsofia Nagy1, Zsuzsanna Kis2, Zoltan Som1, Tamas Geczy2, Csaba Foldesi1, Andras Temesvari1, Attila Kardos1
1 Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
2 Erasmus Medical Center, Rotterdam, Netherlands
Introduction: Persistent iatrogenic atrial septal defect (iASD) after transseptal puncture (TP) for catheter ablation of atrial fibrillation (AF) been described as a complication of the procedure. The ablation technique can affect the incidence of postprocedural iASD.
Methods: The aim of our prospective study was to describe the incidence, echocardiographic characteristics and clinical implications of iASD diagnosed by transoesophageal echocardiography (TEE) using the radiofrequency (RF) and cryoballoon (CB) ablation techniques. Between July 2014 and September 2016, 94 pts [RF: 48, CB: 46, 30 (31.9%) women, mean age = 60 ± 9.7 years] with paroxysmal AF were enrolled, who had undergone an ablation procedure. TEE was performed the day before the procedure to prove the intact interatrial septum. Following the procedure, TEE was accomplished at 3-month follow-up (FU) for the evaluation of iASD. TEE was repeated at the 12-month FU only in those pts who presented with iASD at 3-month.
Results: At 3-month FU, persistent iASDs with left-to-right shunt were discovered in 17 pts (18.1%). In 9 pts in the RF (18.8%) and in 8 pts in the CB group (17.4%). The mean diameter of the IASD was similar between the investigated groups (RF: 2.2±1.1 mm vs CB: 2.5±1.4 mm). At 12-month FU, the iASDs were closed in 8 out of 9 pts in the RF group (88.9%) and 6 out of 8 pts in the CB group (75%). During the 12-month FU period, none of patients died or suffered from cerebral or cardiac embolism.
Conclusion: Persistent iASD is a relatively common complication following AF ablation procedures. No difference was observed between the RF and CB groups concerning the presence of iASD at 3-month. iASDs show a high spontaneous closure rate of 82.4% after a 12-month FU period. No adverse clinical events were recorded in these patient cohorts.
Doctoral School: Basic Medicine
Program: Cardiovascular Disorders, Electrophysiology
Supervisor: Attila Kardos MD., PhD.
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