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A Novel Puncturable Atrial Septal Defect Occluder: The Results of Preclinical Experiment and First-in-Human Study. JACC Basic Transl Sci 2022; 7:1200-1210. [PMID: 36644281 PMCID: PMC9831856 DOI: 10.1016/j.jacbts.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/07/2022]
Abstract
ReAces is a novel puncturable transcatheter atrial septal defect occluder. The device success rate was 100% (n = 14 of 14) in the animal experiment. Four swine successfully received puncture of the device 60 days after implantation of the device. The acute procedure success rate in the 10 patients was 100%. Transthoracic echocardiography examination showed that the devices were well positioned with no residual shunt, and the area of central portion of occluder was substantially thin. It is safe and effective to use ReAces for closure of secundum atrial septal defect, and puncture the atrial septum at the portion of the device is feasible.
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Himelfarb JD, Shulman H, Olesovsky CJ, Rumman RK, Oliva L, Friedland J, Farrell A, Huszti E, Horlick E, Abrahamyan L. Atrial fibrillation following transcatheter atrial septal defect closure: a systematic review and meta-analysis. Heart 2021; 108:1216-1224. [PMID: 34675040 DOI: 10.1136/heartjnl-2021-319794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset atrial fibrillation and flutter (AFi/AFl). These arrhythmias confer an increased risk of postoperative stroke, thrombus formation and systemic emboli. This systematic review examines the burden of de novo AFi/AFl in adults following transcatheter closure and seeks to identify risk factors for AFi/AFl development. METHODS Studies were identified by a search of MEDLINE, EMBASE and Cochrane databases from inception until 29 April 2020. A meta-analysis of AFi/AFl incidence was performed using a random-effects model. RESULTS A total of 31 studies met inclusion criteria, comprising 4788 adult patients without a history of AFi/AFl. Twenty-three studies were included in quantitative synthesis and demonstrated an overall incidence rate of 1.82 patients per 100 person-years of follow-up (I2=83%). In studies that enrolled only patients ≥60 years old, the incidence was 5.21 patients per 100 person-years (I2=0%). Studies with follow-up duration ≤2 years reported an incidence of 4.05 per 100 person-years (I2=55%) compared with a rate of 1.19 per 100 person-years (I2=85%) for studies with follow-up duration >2 years. CONCLUSIONS The incidence of new-onset AFi/AFl is relatively low following transcatheter closure of secundum ASDs. The rate of de novo AFi/AFl, however, was significantly higher in elderly patients. Shorter follow-up time was associated with a higher reported incidence of AFi/AFl.
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Affiliation(s)
| | - Healey Shulman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Rawan K Rumman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura Oliva
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Joshua Friedland
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Farrell
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Ella Huszti
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Biostatistics Research Unit, University Health Network, Toronto, Ontario
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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