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Oates CP, Towheed A, Hadadi CA. Refractory hypoxemia from intracardiac shunting following ventricular tachycardia ablation in a patient with a left ventricular assist device. HeartRhythm Case Rep 2022; 8:760-764. [PMID: 36618602 PMCID: PMC9811018 DOI: 10.1016/j.hrcr.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Connor P. Oates
- Address reprint requests and correspondence: Dr Connor P. Oates, MedStar Georgetown University–Washington Hospital Center, 110 Irving St NW, Washington, DC 20310.
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Chiam PTL, Lim CP, Hsu LF, Liew R. Iatrogenic atrial septal defect after catheter ablation-to close or not to close? ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:441-443. [PMID: 35906943 DOI: 10.47102/annals-acadmedsg.202249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Paul T L Chiam
- The Heart and Vascular Centre, Mount Elizabeth Hospitals, Singapore
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Nelles D, Vij V, Al-Kassou B, Weber M, Vogelhuber J, Beiert T, Nickenig G, Schrickel JW, Sedaghat A. Incidence, persistence, and clinical relevance of iatrogenic atrial septal defects after percutaneous left atrial appendage occlusion. Echocardiography 2021; 39:65-73. [PMID: 34921426 DOI: 10.1111/echo.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/29/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the rate and clinical impact of a persisting iatrogenic atrial septal defect (iASD) after percutaneous left atrial appendage occlusion (LAAO). BACKGROUND Percutaneous LAAO is an alternative to oral anticoagulation (OAC) for the prevention of ischemic stroke and systemic embolism in patients with atrial fibrillation (AF). Data regarding incidence and persistence of iASD after LAAO procedures and its clinical relevance is scarce. METHODS We retrospectively analyzed 144 patients that underwent LAAO at our center between 2009 and 2020 who had at least one follow-up including transesophageal echocardiography (TEE). Baseline clinical, procedural data and echocardiographic characteristics in patients with and without evidence of an iASD were compared. We furthermore determined the rate of iASD persistence over time and evaluated outcomes of patients with and without spontaneous iASD closure. RESULTS After a median of 92 days (IQR 75-108 days) after LAAO, 50 patients (50/144, 34.7%) showed evidence of an iASD. Patients with iASD had higher CHADS-VASc-scores (4.9±1.5 vs 4.2±1.2, p = 0.03), larger left atrial volumes (80.5±30.5 ml vs 67.1±19.7 ml, p = 0.01) and were more likely to have relevant mitral regurgitation (≥° II) (46.0% vs 12.3%, p = 0.001). LAAO procedures took longer (50.1±24.3 vs 41.1±17.8 min, p = 0.06) in patients with a persisting iASD. Furthermore, larger device sizes were implanted (24.3±3.4 mm vs 22.1±2.8 mm, p = 0.03). The presence of an iASD had no impact on RV dysfunction, thromboembolism or mortality. Spontaneous closure of an iASD was documented in 52.0% (26/50). Hereby, similar risk factors were identified for the persistence of an iASD in follow-up.
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Affiliation(s)
- Dominik Nelles
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | - Vivian Vij
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | | | - Marcel Weber
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | | | - Thomas Beiert
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | - Georg Nickenig
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
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Reddy SA, Nethercott SL, Khialani BV, Virdee MS. Pulmonary vein isolation for atrial fibrillation: Does ablation technique influence outcome? Indian Heart J 2021; 73:718-724. [PMID: 34743897 PMCID: PMC8642637 DOI: 10.1016/j.ihj.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Over the last 20 years various techniques have been developed striving for safer and more durable pulmonary vein isolation (PVI). The three most commonly used tools are pulmonary vein ablation catheter (PVAC) and cryoballoon ('single-shot' techniques), and point-by-point (PBP) radiofrequency ablation using 3D electroanatomical mapping (EAM). OBJECTIVE Evaluate the safety and efficacy of the different techniques in an unselected population undergoing de-novo ablation for persistent or paroxysmal atrial fibrillation (AF) at Royal Papworth Hospital (RPH). METHOD Retrospective, single-centre study of consecutive AF ablations at RPH between March 2017 and April 2018. Demographic, procedural and outcome data were analysed. RESULTS Over the study period 329 first-time PVI procedures were performed. 37.4% were performed using PBP, 39.8% using cryoballoon and 22.8% using PVAC. There was no significant difference in age or sex between different ablation technique groups. 238 procedures were performed for paroxysmal AF and 91 for persistent AF. A higher proportion of the persistent cases were performed using point-by-point techniques compared to paroxysmal cases (58.2% vs 29.0%, p < 0.05). Procedural times were significantly longer in the group undergoing PBP ablation compared to cryoballoon or PVAC. However, there was no statistically significant difference in 12-month freedom from symptomatic AF or procedural complications between the groups. CONCLUSIONS PBP, PVAC and cryoballoon AF ablation all appeared equally efficacious in an unselected population, though PVAC and cryoballoon procedures were shorter. All procedures were associated with a low adverse event rate. Prospective examination is required to substantiate this finding.
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Affiliation(s)
- S A Reddy
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
| | | | - B V Khialani
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
| | - M S Virdee
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
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Wang S, Zhao L, Wang Y, Yin X, Yang X, Liu Y. A modified percutaneous atrial balloon septoplasty for difficult transseptal puncture. Medicine (Baltimore) 2021; 100:e26525. [PMID: 34260528 PMCID: PMC8284759 DOI: 10.1097/md.0000000000026525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/12/2021] [Indexed: 01/04/2023] Open
Abstract
Catheter ablation of atrial fibrillation sometimes encounters difficulty in passing the interatrial septum. This study reports a modified percutaneous atrial balloon septoplasty with short balloon to gain access to left atrium (LA) during challenging transseptal puncture (TSP).We retrospectively analyzed 20 patients (61.75 ± 7.31 years, 45% male) who received modified percutaneous atrial balloon septoplasty from August 2015 to October 2018. Soft-headed balance middle weight (BMW) guidewire was inserted into left superior pulmonary vein (LSPV) and short non-compliant balloon (15 mm in length and 4.0 or 5.0 mm in diameter) was used for atrial balloon septoplasty (ABS). Interatrial septum was located with inflated balloon and contrast "Hitting Wall" sign. All patients were followed-up for iatrogenic atrial septal defect (iASD) and other related complications.ABS and LA access were performed successfully without complications in all 20 patients. Time needed for ABS was correlated to the number of prior TSP (P = .007). During the 6-month follow-up, no remaining iASD was found by echocardiography.For atrial fibrillation patients with difficulty in passing the interatrial septum, this modified percutaneous ABS might be an alternative strategy which is safe to obtain transseptal access without short or long term complications.
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Reddy SA, Nethercott SL, Khialani BV, Grace AA, Martin CA. Management of arrhythmias in pulmonary hypertension. J Interv Card Electrophysiol 2021; 62:219-229. [DOI: 10.1007/s10840-021-00988-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022]
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Outcomes of atrial fibrillation ablation program based on single-shot techniques. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:466-473. [PMID: 33598021 PMCID: PMC7863826 DOI: 10.5114/aic.2020.101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Single-shot techniques such as cryoballoon and multipolar phased pulmonary vein ablation catheter (PVAC) are an alternative to the point-by-point radiofrequency method for atrial fibrillation (AF) ablation. However, there is a lack of data concerning sequential use of single-shot techniques, that is, for both the index and redo ablation. Aim To assess long-term outcomes of the ‘single-shot techniques only’ AF ablation strategy. Material and methods We analyzed all consecutive AF ablations performed over a 10-year period (2009–2019) in a center where a ‘single-shot technique only’ principle was followed from the start of the AF ablation program. Kaplan-Meier AF-free survival curves were calculated and complications were assessed on the basis of our prospectively maintained database. Results A total of 597 patients (62.4 ±12.5 years) with paroxysmal (78.1%) or persistent (21.9%) AF entered the study and 655 AF ablation procedures were performed. In 96.5% of redos (n = 58) a different technique (mostly PVAC) was used than for the index ablation (mostly cryoballoon). The Kaplan-Meier estimates of 1, 2 and 5 years freedom from AF were 78.2%, 69.2%, and 56.0%, for the index ablation, and 80.3%, 76.1% and 68.3%, for the redo, respectively. The minor and major complication rates were 8.1%, and 4.0%, respectively. Conclusions An AF ablation program based solely on sequential use of two different single-shot techniques for both index and redo procedures is safe and effective. These observations might have important practical implications for new operators/centers starting AF ablation programs and for use of single-shot techniques for redo procedures.
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Matar F, Welter-Frost A. Management of Iatrogenic Atrial Septal Defects in the Era of Large-Bore Transcatheter Mitral Valve Therapies. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 31:83-88. [PMID: 33339771 DOI: 10.1016/j.carrev.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/14/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022]
Abstract
Several case reports described acute and subacute decompensations that were reversed after percutaneous interatrial septal defect (ASD) closure. At least 30% of patients post MitraClip will continue to have a persistent ASD at 1 year. Few retrospective studies described various echocardiographic associations with persistent ASD but there is no conclusive evidence that it is the cause of a poor outcome. Conclusion: At this time routine closure of ASD post MitraClip is not recommended unless there is hemodynamic decompensation that cannot be explained by other factors.
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Affiliation(s)
- Fadi Matar
- University of South Florida Morsani College of Medicine, Department of Cardiovascular Sciences, Tampa, FL, United States of America; Tampa General Hospital, Tampa, FL, United States of America.
| | - Allan Welter-Frost
- University of South Florida Morsani College of Medicine, Department of Cardiovascular Sciences, Tampa, FL, United States of America; Tampa General Hospital, Tampa, FL, United States of America
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Keeping it Simple: Balloon Devices for Atrial Fibrillation Ablation Therapy. JACC Clin Electrophysiol 2020; 6:1577-1596. [PMID: 33213820 DOI: 10.1016/j.jacep.2020.08.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation is a common disease of increasing prevalence. Catheter ablation has evolved into an established therapeutic option that mainly aims to electrically isolate the pulmonary veins from atrial myocardium. The traditional method comprises point-by-point radiofrequency current ablation guided by electroanatomical mapping and has proven to be effective and safe in experienced hands. However, this approach is technically highly demanding and associated with a long learning curve, limiting its widespread utilization. To address these shortcomings, simplified ablation tools for pulmonary vein isolation are needed. In this context, balloon devices promise to ease the procedure by approaching the entire orifice of a targeted pulmonary vein in a single maneuver. This requires less catheter manipulation in the left atrium and often allows ablation of a large volume of tissue with a single application of ablative energy. Two balloon devices-one using cryoenergy, the other laser energy-have already been established in clinical routine and have demonstrated noninferiority when compared with radiofrequency ablation in large randomized trials. More balloon devices are on the verge of being introduced into clinical practice and bear the potential to expand the interventional electrophysiologist's armamentarium when treating atrial fibrillation. The authors review the use of the established balloon devices available for atrial fibrillation ablation and provide a detailed outlook on upcoming balloon technologies, including 3 different balloons utilizing radiofrequency energy as well as a novel cryoballoon.
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A novel and easy approach to difficult transseptal puncture during atrial fibrillation ablation. J Interv Card Electrophysiol 2020; 62:269-276. [PMID: 33034794 DOI: 10.1007/s10840-020-00891-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
AIMS Transseptal passage is sometimes difficult to obtain. This study evaluates the feasibility and safety of a novel and easy transseptal puncture (TSP) technique named 2D2G (using two dilators and two guidewires) in patients with difficult TSP. METHODS AND RESULTS Forty-four paroxysmal atrial fibrillation patients with difficult TSP were enrolled in this study. They were allocated to the 2D2G group or the conventional group in a 1:1 fashion. The primary endpoint in both groups was successful TSP without changing the puncture site or using auxiliary tools. The secondary endpoints were the safety, total transseptal puncture time, and ablation time. There were no differences in baseline demographic or clinical characteristics between the two groups. Successful LA access in the 2D2G group was 100% (vs. 64%, P < 0.05). The total TSP time (10 ± 3 min vs. 5 ± 1 min, P < 0.05) and ablation time (42 ± 19 min vs. 58 ± 22 min, P < 0.05) in the conventional group were significantly longer than those in the 2D2G group. No major complications occurred in either group, and all the patients underwent successful circumferential pulmonary vein isolation (CPVI). CONCLUSION In AF patients with difficult TSP, the 2D2G technique is safe, feasible, and time-saving.
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Mattia A, Newman J, Manetta F. Treatment Complications of Atrial Fibrillation and Their Management. Int J Angiol 2020; 29:98-107. [PMID: 32476810 DOI: 10.1055/s-0039-3401794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Atrial fibrillation (AF) is a rhythm disturbance defined by irregular, rapid electrical, and mechanical activation of the atria, which causes unsynchronized atrial contraction and promotes thromboembolism. AF is the most common sustained arrhythmia. Its prevalence and incidence are increasing due to aging and improved survival from acute heart diseases. This article is a review on AF management from both a surgical and catheter-based perspective. While both treatment approaches to AF have been shown to be successful in the management of AF, they are not without their own inherent complications. This article seeks to review some of these complications and help to guide treatment.
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Affiliation(s)
- Allan Mattia
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Joshua Newman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Frank Manetta
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
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The influence of iatrogenic atrial septal defect on the prognosis of patients with atrial fibrillation between cryoablation and radiofrequency ablation. Biosci Rep 2020; 40:221856. [PMID: 31930391 PMCID: PMC7007401 DOI: 10.1042/bsr20193128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/22/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The present study was to compare the incidence of septal defect (SD) in patients with atrial fibrillation (AF) who received radiofrequency ablation or cryoablation. METHODS A total of 293 AF patients were performed with radiofrequency ablation and cryoablation. Cardiac ultrasonography was performed to calculate left atrial diameter (LAD), left atrial ejection fraction (LAEF%), strain rate (SR), left ventricular systolic (SRs), left ventricular diastolic (SRe), and left atrial systole (SRa) before surgery, 3 months and 1 year after surgery. The patients were followed up to observe statin and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) medication, AF recurrence, 6-min walk test, stroke, any symptoms caused by arrhythmia, and re-hospitalization. RESULTS The levels of LAD and SD were higher, while SRe and SRa were lower in the cryoablation group in the comparison with the radiofrequency ablation group after surgery (P<0.05). LAEF was lower in the cryoablation group than the radiofrequency ablation group after 3 months (P<0.05). After 1-year follow-up, no right-to-left shunt occurred in all patients with SD. The AF recurrence rate in SD group was higher than that in the normal group (P<0.05). The use of statin and the application of ACEI/ARB were protective factors, whereas hypertension, LAD, left atrial operation time, and surgical plan were risk factors. CONCLUSION SD affects left atrial function and increases the risk of AF recurrence. Hypertension, LAD, and left atrial operation time are risk factors for SD, whereas statin and ACEI/ARB drugs can reduce SD.
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Aksu T, Yalin K, Guler TE, Bozyel S, Heeger CH, Tilz RR. Acute Procedural Complications of Cryoballoon Ablation: A Comprehensive Review. J Atr Fibrillation 2019; 12:2208. [PMID: 32435335 DOI: 10.4022/jafib.2208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
Abstract
Catheter ablation is increasingly performed for treatment of atrial fibrillation (AF). Balloon based procedures have been developed aiming at safer, easier and more effective treatment as compared to point to point ablation. In the present review article, we aimed to discuss acute procedural complications of cryoballoon ablation.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Istanbul University- Cerrahpasa, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.,University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tumer Erdem Guler
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Christian-H Heeger
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
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Thromboembolic Events Following Atrial Fibrillation Cardioversion and Ablation: What's the Culprit? MEDICINA-LITHUANIA 2019; 55:medicina55080505. [PMID: 31434315 PMCID: PMC6723553 DOI: 10.3390/medicina55080505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Stroke is a rare but possible complication after atrial fibrillation (AF) ablation. However, its etiopathogenesis is far from being completely characterized. Here we report a case of stroke, with recurrent peripheral embolism after AF ablation procedure. In our patient, an in situ femoral vein thrombosis and iatrogenic atrial septal defect were simultaneously detected. A comprehensive review of multiple pathophysiological mechanisms of stroke in this context is provided. The case underlines the importance of a global evaluation of patients undergoing AF ablation.
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Prospective evaluation of iatrogenic atrial septal defect after cryoballoon or radiofrequency catheter ablation of atrial fibrillation-"EVITA" study. J Interv Card Electrophysiol 2019; 56:19-27. [PMID: 31399921 DOI: 10.1007/s10840-019-00598-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Iatrogenic atrial septal defect (IASD) after catheter ablation (CA) for atrial fibrillation (AF) due to transseptal puncture (TSP) can occur. The aim of this prospective study was to describe the incidence of IASD and to detect any cerebrovascular accident (CVA) after radiofrequency (RF) and cryoballoon (CB) CA. METHODS Between July 2014 and September 2016, 94 patients (pts) (RF; 48, CB; 46, 30 (31.9%) women, mean age = 60 ± 9.7 years) with paroxysmal AF were enrolled who underwent CA procedure for the first time. During RF ablation a single (n = 30, 62.5%) or double (n = 18, 37.5%) TSP was performed. Transoesophageal echocardiography before the procedure and at the 3-month and 12-month follow-up (FU) was accomplished. During the FU period, we evaluated the occurrence of any postprocedural CVA. RESULTS At the 3-month FU, IASD was detected in 17/94 (18.1%) pts; in 9/48 (18.8%) pts in the RF while in 8/46 (17.4%) pts in the CB group (p = 0.866), all of them with left-to-right shunt. In the RF group, 6/30 (20%) pts with a single TSP while 3/18 (16.7%) pts in the double TSP group had IASD (p = 0.780). 14/17 (82.4%) IASDs showed high spontaneous closure rate at the 12-month FU. None of the pts died or suffered from CVA. CONCLUSION Persistent IASD can occur rather frequently following AF CA. No significant difference was observed between the RF and CB techniques concerning the presence of IASD at 3-month. IASDs showed a high spontaneous closure rate. No cerebral thromboembolic event was observed in the 12-month FU period.
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Hong KL, Glover BM. Iatrogenic Atrial Septal Defects After Transseptal Access for Atrial Fibrillation Ablations. Can J Cardiol 2019; 35:368-369. [PMID: 30935624 DOI: 10.1016/j.cjca.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Kathryn L Hong
- Schulich Heart Center, Sunnybrook Hospital, University of Toronto, Ontario, Canada
| | - Benedict M Glover
- Schulich Heart Center, Sunnybrook Hospital, University of Toronto, Ontario, Canada.
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Chan NY, Choy CC, Yuen HC, Chow HF, Fong HF. A Very Long-term Longitudinal Study on the Evolution and Clinical Outcomes of Persistent Iatrogenic Atrial Septal Defect After Cryoballoon Ablation. Can J Cardiol 2019; 35:396-404. [DOI: 10.1016/j.cjca.2018.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/15/2018] [Accepted: 12/15/2018] [Indexed: 11/15/2022] Open
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Jasper R, Oren J, Blankenship JC. Percutaneous Closure of Persistent Atrial Septal Defects After Pulmonary Vein Isolation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:1020-1022. [PMID: 30581089 DOI: 10.1016/j.carrev.2018.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
Pulmonary vein isolation (PVI) with radiofrequency or cryoballoon ablation to treat atrial fibrillation requires trans-septal puncture. This creates a small iatrogenic atrial septal defect (iASD). In most patients, the defect spontaneously closes after 3-6 months. However, persistent iASDs can cause hemodynamic changes and adverse consequences from inter-atrial shunting. Persistent post PVI iASDs that are clinically significant can be closed percutaneously. This diagnosis should be considered in patients with worsening dyspnea or fatigue after PVI. We present a case of post PVI iASDs causing immediate or late onset hemodynamic changes and clinical symptoms, which improved after ASD closure. We provide a review of previously reported cases and literature on post PVI ASD prevalence, risk factors and outcomes after ASD closure.
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Affiliation(s)
- Rosie Jasper
- Department of Cardiology, Geisinger Medical Center, 100 North Academy Drive, Danville, PA, United States of America.
| | - Jess Oren
- Department of Cardiology, Geisinger Medical Center, 100 North Academy Drive, Danville, PA, United States of America
| | - James C Blankenship
- Department of Cardiology, Geisinger Medical Center, 100 North Academy Drive, Danville, PA, United States of America
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Ciconte G, Coulombe N, Brugada P, de Asmundis C, Chierchia GB. Towards a tailored cryo-pulmonary vein isolation. Lessons learned from second-generation cryoballoon ablation. Trends Cardiovasc Med 2018; 29:420-425. [PMID: 30552043 DOI: 10.1016/j.tcm.2018.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/30/2018] [Accepted: 11/12/2018] [Indexed: 01/08/2023]
Abstract
Second-generation cryoballoon ablation has emerged as an effective and practical approach for the treatment of atrial fibrillation. It gained the overall interest of the electrophysiology community due to its excellent success rates, and reproducible clinical outcomes comparable to the point-by-point radiofrequency technique. This technology offers several advantages including a fast learning curve and shorter procedure times making this device widely adopted in many EP-laboratories as an alternative strategy to conventional point-by-point radiofrequency ablation. As compared to its predecessor, the improved technical performances of the second-generation cryoballoon translated into favorable clinical outcomes, which are maintained in long-term follow-up. However, the ideal cryo-application duration and the adequate number of freeze-thaw cycles are not well established and predictors of durable electrical isolation are poorly known. This review provides some practical advices for a successful ablation using the second-generation cryoballoon.
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Affiliation(s)
- Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.
| | | | - Pedro Brugada
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
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Eshcol J, Wimmer AP. Hemodynamically significant iatrogenic atrial septal defects after cryoballoon ablation. HeartRhythm Case Rep 2018; 5:17-21. [PMID: 30693199 PMCID: PMC6342334 DOI: 10.1016/j.hrcr.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jayasheel Eshcol
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Alan P Wimmer
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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Blockhaus C, Waibler HP, Gülker JE, Klues H, Bufe A, Shin DI. Evasion maneuver for transseptal approach during cryoballoon pulmonary vein isolation. J Saudi Heart Assoc 2018; 30:301-304. [PMID: 30069135 PMCID: PMC6067055 DOI: 10.1016/j.jsha.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/11/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose Pulmonary vein isolation (PVI) is a cornerstone therapy in patients with symptomatic atrial fibrillation. One current method is performing a PVI using a cryoballoon (CB). The CB is inserted into the left atrium via a steerable sheath. However, at times, passing of the interatrial septum by the sheath is hindered, e.g., due to septal fibrosis. Here we report our experience with an evasion maneuver to facilitate this approach using a 6F multipolar and steerable coronary Sinus catheter (CS) for predilatation of the interatrial septum. Methods and results We report 10 patients undergoing a CB-PVI, where the investigator experienced difficulties in passing the interatrial septum with the CB sheath. In these cases, after three conventional abortive attempts, we predilated the transseptal puncture site using both the CS catheter and the dilatator of the CB sheath. Thereafter access of the CB sheath to the left atrium could be achieved instantly and without further resistance. Conclusion We report a safe and feasible maneuver to facilitate transseptal access with the CB steerable sheath in cases complicated by excessive interatrial resistance.
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Affiliation(s)
- Christian Blockhaus
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
- Corresponding author at: Department of Cardiology, Heart Centre Niederrhein, Helios Clinics, Lutherplatz 40, 47805 Krefeld, Germany.
| | - Hans-Peter Waibler
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
| | - Jan-Erik Gülker
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
| | - Heinrich Klues
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
| | - Alexander Bufe
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
- University Witten/Herdecke, Witten, Germany
| | - Dong-In Shin
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
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Bailout Atrial Balloon Septoplasty to Overcome Challenging Left Atrial Transseptal Access for Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2018; 4:1011-1019. [DOI: 10.1016/j.jacep.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/26/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022]
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Naksuk N, Asirvatham SJ. Iatrogenic atrial septal defect: reassurance or inquisitiveness. J Interv Card Electrophysiol 2018; 52:137-140. [DOI: 10.1007/s10840-018-0369-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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Linhart M, Werner JT, Stöckigt F, Kohlmann AT, Lodde PC, Linneborn LPT, Beiert T, Hammerstingl C, Borràs R, Nickenig G, Andrié RP, Schrickel JW. High rate of persistent iatrogenic atrial septal defect after single transseptal puncture for cryoballoon pulmonary vein isolation. J Interv Card Electrophysiol 2018; 52:141-148. [DOI: 10.1007/s10840-018-0352-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
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Manolis AS. Transseptal Access to the Left Atrium: Tips and Tricks to Keep it Safe Derived from Single Operator Experience and Review of the Literature. Curr Cardiol Rev 2018; 13:305-318. [PMID: 28969539 PMCID: PMC5730964 DOI: 10.2174/1573403x13666170927122036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Transseptal puncture (TSP) remains a demanding procedural step in accessing the left atrium with inherent risks and safety concerns, mostly related to cardiac tamponade. OBJECTIVE Based on our own experience with 249 TSP procedures and in-depth literature review, we present our results and offer several tips and tricks that may render TSP successful and safe. METHODS This prospective study comprised 249 consecutive patients (146 men), aged 41.6±17.4 years, undergoing TSP by a single operator for ablation of a variety of arrhythmias, mostly related to left accessory pathways (n=145) or left atrial tachycardias (n=33) and more recently, atrial fibrillation (n=70). TSP was guided by fluoroscopy alone in all patients without the use of echocardiography imaging. In addition, an extensive literature review of TSP-related topics was carried out in PubMed, Scopus and Google Scholar. RESULTS Among 249 patients, 33 patients were children or young adolescents (aged 7-18 years); 14 patients were undergoing a repeat procedure. Patients with a manifest accessory pathway were the youngest (mean age 33.7±15.9) and patients with atrial fibrillation the oldest (mean age 56.0±10.8 years). A successful TSP was accomplished in 247 patients (99.2%). Two (0.8%) procedures were complicated by cardiac tamponade managed successfully with pericardiocentesis or surgical drainage. Review of the literature revealed no systematic reviews and meta-analyses of TSP studies; however, several patient series have documented that fluoroscopy-guided TSP, with various modifications in the technique employed in the present series, have been effective in 95-100% of the cases with a complication rate ranging from 0.0% to 6.7%, albeit with a mortality rate of 0.018%- 0.2%. Echo imaging techniques were employed in cases with difficult TSP. CONCLUSION Employing a standardized protocol with use of fluoroscopy alone minimized serious complications to 0.8% (2 patients) among 249 consecutive patients undergoing TSP for ablation of a variety of cardiac arrhythmias. Based on this single-operator experience and review of the literature, a list of practical tips and tricks is provided for a successful and safe procedure, reserving the more expensive and patient inconveniencing echo-imaging techniques for difficult or failed cases.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Vas. Sofias 114, Athens 115 27. Greece
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Wanamaker B, Cascino T, McLaughlin V, Oral H, Latchamsetty R, Siontis KC. Atrial Arrhythmias in Pulmonary Hypertension: Pathogenesis, Prognosis and Management. Arrhythm Electrophysiol Rev 2018; 7:43-48. [PMID: 29636972 DOI: 10.15420/aer.2018.3.2] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Atrial arrhythmias, including atrial fibrillation and atrial flutter, are common in patients with pulmonary hypertension and are closely associated with clinical decompensation and poor clinical outcomes. The mechanisms of arrhythmogenesis and subsequent clinical decompensation are reviewed. Practical implications and current evidence for the management of atrial arrhythmias in patients with pulmonary hypertension are summarised.
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Affiliation(s)
| | | | | | - Hakan Oral
- University of MichiganAnn Arbor, MI, USA
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Salghetti F, Sieira J, Chierchia GB, Curnis A, de Asmundis C. Recognizing and reacting to complications of trans-septal puncture. Expert Rev Cardiovasc Ther 2017; 15:905-912. [PMID: 29161923 DOI: 10.1080/14779072.2017.1408411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The transseptal puncture (TSP) enables access to the left heart, through the fossa ovalis (FO), both in electrophysiology and in cardiac interventional procedures. TSP is usually safe in experienced hands. Sometimes TSP can be technically demanding and carries the risk of severe complications in approximately 1%. While performing a TSP, every effort should be taken in order to avoid complications. In the event of complications, prompt recognition and reaction are essential and a combined 'heart-team' management may be the most effective approach. Areas covered: Main TSP-related complications are cardiac tamponade, aortic root puncture, embolic stroke, transient ST elevation of inferior leads and iatrogenic atrial septal defect. A challenging TSP may be expected in presence of difficult IAS-FO anatomies, previous TSP, IAS occluder device and previous IAS surgical repair. Use of echo imaging and special needles (ie., radiofrequency needle and J-shaped guidewire) may avoid TSP-related complications in difficult settings. Expert commentary: Some tools are available to help minimize the risks of TSP. However, their availability might be limited. To increase safety of TSP, an adequate training of physicians, identification of patients in whom it might be difficult and a prompt recognition of complications seem to be the most important background.
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Affiliation(s)
- Francesca Salghetti
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium.,b Division of Cardiology , Spedali Civili Hospital, Università degli Studi di Brescia , Brescia , Italy
| | - Juan Sieira
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Gian-Battista Chierchia
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Antonio Curnis
- b Division of Cardiology , Spedali Civili Hospital, Università degli Studi di Brescia , Brescia , Italy
| | - Carlo de Asmundis
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
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Reissmann B, Metzner A, Kuck KH. Cryoballoon ablation versus radiofrequency ablation for atrial fibrillation. Trends Cardiovasc Med 2017; 27:271-277. [DOI: 10.1016/j.tcm.2016.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 12/17/2022]
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Holmqvist F, Daubert JP. Editorial commentary: Atrial fibrillation ablation with cryoenergy: It׳s "Cool"; it׳s "Non-inferior"; Is it better? Trends Cardiovasc Med 2017; 27:278-279. [PMID: 28254351 DOI: 10.1016/j.tcm.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Fredrik Holmqvist
- Clinical Cardiac Electrophysiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - James P Daubert
- Clinical Cardiac Electrophysiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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O'Brien B, Zafar H, De Freitas S, Sharif F. Transseptal puncture - Review of anatomy, techniques, complications and challenges. Int J Cardiol 2017; 233:12-22. [PMID: 28202256 DOI: 10.1016/j.ijcard.2017.02.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/22/2016] [Accepted: 02/01/2017] [Indexed: 12/17/2022]
Abstract
In recent years, the transseptal puncture approach has enabled passage of increasingly large and complex devices into the left atrium. Traditional tools remain effective in creating and dilating the initial puncture, with an acceptable safety profile. Even for skilled operators, the procedure is technically demanding and requires sound understanding of atrial anatomy. Intracardiac echocardiography is useful in cases of previous septal repair, poorly defined fossa ovalis anatomy or when considering patent foramen ovale portal crossing. Iatrogenic atrial septal defect (iASD) is the most commonly encountered long-term complication and there is increasing evidence that larger devices are leading to symptomatic defects. The size of the sheath crossing the septum is the strongest predictor of iASD formation but other factors such as longer procedure times, significant catheter manipulation and high pulmonary pressures also contribute. Transcatheter mitral valve repair involves the use of large 22 Fr catheters which carry alarmingly high rates of defect persistence with precipitation of symptoms and possible influence on mortality. Long-term follow up data, particularly beyond the 12-month period are lacking and resultantly, evidence to guide management is sparse. Refinements of conventional instruments, as well as innovations to puncture the septum without mechanical pressure, herald a progressively safer future for the transseptal technique.
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Affiliation(s)
- Barry O'Brien
- Biomedical Engineering, School of Engineering & Informatics, National University of Ireland (NUI), Galway, Ireland
| | - Haroon Zafar
- Cardiovascular Research Centre Galway, School of Medicine, NUI, Galway, Ireland; School of Medicine, NUI, Galway, Ireland.
| | - Simon De Freitas
- Cardiovascular Research Centre Galway, School of Medicine, NUI, Galway, Ireland; School of Medicine, NUI, Galway, Ireland
| | - Faisal Sharif
- Cardiovascular Research Centre Galway, School of Medicine, NUI, Galway, Ireland; School of Medicine, NUI, Galway, Ireland; Department of Cardiology, University Hospital Galway, Ireland; BioInnovate, Ireland; CÚRAM, SFI Centre for Research in Medical Devices, Galway, Ireland
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Davies A, Gunaruwan P, Collins N, Barlow M, Jackson N, Leitch J. Persistent iatrogenic atrial septal defects after pulmonary vein isolation: long-term follow-up with contrast transesophageal echocardiography. J Interv Card Electrophysiol 2016; 48:99-103. [PMID: 27683061 DOI: 10.1007/s10840-016-0193-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/16/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE Pulmonary vein isolation using cryoballoon ablation is an established approach to treating atrial fibrillation. The procedure involves insertion of a 15-Fr sheath into the left atrium across the interatrial septum. This creates an iatrogenic atrial septal defect, which may have important long-term clinical relevance, especially in younger patients. We sought to determine the long-term incidence of these defects and determine the direction of shunt using contrast transesophageal echocardiography. METHODS Individuals who had undergone a single pulmonary vein isolation procedure were invited to attend for transesophageal echocardiography (TOE). Patients who had undergone more than one procedure involving puncture of the interatrial septum were excluded. The interatrial septum was interrogated using two-dimensional imaging, color flow Doppler, and microbubble contrast study. RESULTS A total of 27 patients were recruited with a median follow-up time of 553 days from pulmonary vein isolation to TOE. Seven patients had persistent iatrogenic atrial septal defects with three demonstrating right to left shunt either at rest or with Valsalva. There were no reported adverse events during the study period. CONCLUSIONS Persistent iatrogenic atrial septal defects are relatively common following cryoballoon ablation procedures. Right to left shunting can be observed using microbubble contrast in a subset of patients with iatrogenic atrial septal defect (iASD). Further studies that longitudinally assess shunt fraction, pulmonary artery pressure, and the incidence of paradoxical embolism are needed to better understand the clinical impacts of such defects.
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Affiliation(s)
- Allan Davies
- Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, 2305, NSW, Australia.
| | | | - Nicholas Collins
- Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, 2305, NSW, Australia
| | - Malcolm Barlow
- Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, 2305, NSW, Australia
| | - Nick Jackson
- Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, 2305, NSW, Australia
| | - James Leitch
- Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, 2305, NSW, Australia
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Madhavan M, Yao X, Sangaralingham LR, Asirvatham SJ, Friedman PA, McLeod CJ, Sugrue AM, DeSimone CV, Noseworthy PA. Ischemic Stroke or Systemic Embolism After Transseptal Ablation of Arrhythmias in Patients With Cardiac Implantable Electronic Devices. J Am Heart Assoc 2016; 5:e003163. [PMID: 27076562 PMCID: PMC4843539 DOI: 10.1161/jaha.115.003163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Incidental mobile thrombi are commonly found on endovascular leads of cardiac implantable electronic devices (CIEDs). Transseptal puncture for catheter ablation of arrhythmia poses a risk for paradoxical embolism. We examined risk of ischemic stroke, transient ischemic attack (TIA), or systemic embolism after transseptal ablation in patients with and without CIEDs. Methods and Results Using a national administrative claims database, 31 720 patients who underwent a transseptal catheter ablation between January 2004 and September 2014 were identified. Two propensity‐matched cohorts were created by matching demographic variables, administrative variables, Charlson Comorbidity Index, CHA2DS2‐Vasc score, and year and indication for ablation (5533 and 11 300 patients with and without CIEDs). Incidence rates and Cox proportional hazards models were used to estimate risk of ischemic stroke, TIA, or systemic embolism for patients with and without CIEDs. Impact of oral anticoagulation (OAC) use on the endpoint was examined. Over a mean follow‐up of 2.1 years, the incidence of the combined endpoint was 1.9 per 100 person‐years in patients with CIEDs and 1.5 per 100 person‐years in patients without CIEDs (P=0.03). Among patients not on OAC, presence of a cardiac device was associated with an increased risk (hazard ratio [HR], 1.71 [1.24–2.35]; P<0.01), whereas there was no association noted among patients treated with OAC (HR, 0.98 [0.75–1.28]). Conclusion CIEDs are associated with an increased risk of stroke, TIA, or systemic embolism after transseptal ablation, but this risk is attenuated with postablation OAC use. Role of anticoagulation post‐transseptal ablation in patients with CIED warrants further investigation.
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Affiliation(s)
- Malini Madhavan
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN Division of Health Care Policy and Research, Department of Health Services Research, Mayo Clinic, Rochester, MN
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN Optum Labs, Cambridge, MA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Christopher J McLeod
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Peter A Noseworthy
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Alkhouli M, Sarraf M, Zack CJ, Holmes DR, Rihal CS. Iatrogenic atrial septal defect following transseptal cardiac interventions. Int J Cardiol 2016; 209:142-8. [DOI: 10.1016/j.ijcard.2016.02.068] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 11/28/2022]
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Mugnai G, De Asmundis C, Brugada P, Chierchia GB. Reply to Cronin et al., Iatrogenic Atrial Septal Defect after Radiofrequency or Cryoablation of Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:310-1. [PMID: 26643269 DOI: 10.1111/pace.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Centre, UZ Brussel, VUB, 1090, Brussels, Belgium
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, UZ Brussel, VUB, 1090, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, UZ Brussel, VUB, 1090, Brussels, Belgium
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Cronin EM, Collier P, Wazni OM, Griffin BP, Jaber WA, Saliba WI. Iatrogenic Atrial Septal Defect after Radiofrequency or Cryoballoon Ablation of Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:310. [PMID: 26561216 DOI: 10.1111/pace.12780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Edmond M Cronin
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut. .,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
| | - Patrick Collier
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Oussama M Wazni
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Wael A Jaber
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Walid I Saliba
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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