Abstract
Introduction
Atrial fibrillation (AF) is commonly found in patients with structural heart disease (SHD), including atrial septal defect (ASD). The feasibility and safety of ablation for AF in patients with unrepaired ASD is seldom reported.
Objectives
This study aims to evaluate and compare the long-term efficacy of AF ablation in patients with and without ASD.
Methods
From January 2008 to December 2012, 18 consecutive patients were identified with medically refractory AF and an unrepaired ASD under catheter ablation. For each ASD patient, four control subjects were matched from our database.
Results
There were no significant differences between groups in terms of age, sex, type of AF, LA diameter, LVIDD, and EF. The mean procedural and fluoroscopy times were not different between the groups (p = NS). After a median follow-up of 20 months, the patients in the ASD group had 44.4 % AF recurrence after a single procedure compared with 34.7 % in the control group (p = 0.11). The mean LA diameter in non-recurrent patients was smaller than in recurrent patients (p = 0.03). In univariate Cox proportional hazards analyses, the factor found to have a significant association with arrhythmia recurrences was left atrial diameter (hazard ratio 1.059, 95 % confidence interval 1.002 to 1.120, p = 0.03).
Conclusions
These results indicate that in patients with AF and an ASD amenable to percutaneous closure, a staged approach with radiofrequency ablation of AF preceding closure is a rational strategy.
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References
Attie, F., Rosas, M., Granados, N., et al. (2001). Surgical treatment for secundum atrial septal defects in patients >40 years old. A randomized clinical trial. Journal of the American College of Cardiology, 38, 2035–2042.
Nyboe, C., Fenger-Gron, M., Nielsen-Kudsk, J. E., et al. (2013). Closure of secundum atrial septal defects in the adult and elderly patients. European Journal of Cardio-Thoracic Surgery, 43, 752–757.
Jategaonkar, S., Scholtz, W., Schmidt, H., et al. (2009). Percutaneous closure of atrial septal defects: echocardiographic and functional results in patients older than 60 years. Circulation. Cardiovascular Interventions, 2, 85–89.
Berger, F., Vogel, M., Kramer, A., et al. (1999). Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Annals of Thoracic Surgery, 68, 75–78.
Wi, J., Choi, J. Y., Shim, J. M., et al. (2013). Fate of preoperative atrial fibrillation after correction of atrial septal defect. Circulation Journal, 77, 109–115.
Vecht, J. A., Saso, S., Rao, C., et al. (2010). Atrial septal defect closure is associated with a reduced prevalence of atrial tachyarrhythmia in the short to medium term: a systematic review and meta-analysis. Heart, 96, 1789–1797.
Lakkireddy, D., Rangisetty, U., Prasad, S., et al. (2008). 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. Journal of Cardiovascular Electrophysiology, 19, 1137–1142.
Crandall, M. A., Daoud, E. G., Daniels, C. J., et al. (2012). Percutaneous radiofrequency catheter ablation for atrial fibrillation prior to atrial septal defect closure. Journal of Cardiovascular Electrophysiology, 23, 102–104.
Philip, F., Muhammad, K. I., Agarwal, S., et al. (2012). Pulmonary vein isolation for the treatment of drug-refractory atrial fibrillation in adults with congenital heart disease. Congenital Heart Disease, 7, 392–399.
Brockenbrough, E. C., Braunwald, E., & Ross, J., Jr. (1962). Transseptal left heart catheterization. A review of 450 studies and description of an improved technic. Circulation, 25, 15–21.
Dong, J., Liu, X., Long, D., et al. (2009). Single-catheter technique for pulmonary vein antrum isolation: is it sufficient to identify and close the residual gaps without a circular mapping catheter. Journal of Cardiovascular Electrophysiology, 20, 273–279.
Gatzoulis, M. A., Freeman, M. A., Siu, S. C., et al. (1999). Atrial arrhythmia after surgical closure of atrial septal defects in adults. New England Journal of Medicine, 340, 839–846.
Baumgartner, H., Bonhoeffer, P., De Groot, N. M., et al. (2010). ESC guidelines for the management of grown-up congenital heart disease (new version 2010). European Heart Journal, 31, 2915–2957.
Nitta, T., Sakamoto, S., Miyagi, Y., et al. (2013). Reentrant and focal activations during atrial fibrillation in patients with atrial septal defect. Annals of Thoracic Surgery, 96, 1266–1272.
Spies, C., Khandelwal, A., Timmermanns, I., et al. (2008). Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults. American Journal of Cardiology, 102, 902–906.
Giardini, A., Donti, A., Sciarra, F., et al. (2009). Long-term incidence of atrial fibrillation and flutter after transcatheter atrial septal defect closure in adults. International Journal of Cardiology, 134, 47–51.
Li, X., Wissner, E., Kamioka, M., et al. (2014). Safety and feasibility of transseptal puncture for atrial fibrillation ablation in patients with atrial septal defect closure devices. Heart Rhythm, 11, 330–335.
Santangeli, P., Di, B. L., Burkhardt, J. D., et al. (2011). Transseptal access and atrial fibrillation ablation guided by intracardiac echocardiography in patients with atrial septal closure devices. Heart Rhythm, 8, 1669–1675.
Acknowledgments
The authors thank Ting Zhang, Ph.D., for her cooperation with this study and Ju-Yi Wan, M.D., for his technical assistance.
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Nie, JG., Dong, JZ., Salim, M. et al. Catheter ablation of atrial fibrillation in patients with atrial septal defect: long-term follow-up results. J Interv Card Electrophysiol 42, 43–49 (2015). https://doi.org/10.1007/s10840-014-9958-z
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DOI: https://doi.org/10.1007/s10840-014-9958-z