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Prospective evaluation of iatrogenic atrial septal defect after cryoballoon or radiofrequency catheter ablation of atrial fibrillation—“EVITA” study

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

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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Abbreviations

AAD:

Antiarrhythmic drug

AF:

Atrial fibrillation

ASD:

Atrial septal defect

BMI:

Body mass index

CA:

Catheter ablation

CB:

Cryoballoon

CF:

Contact force

CVA:

Cerebrovascular accident

DOAC:

Direct oral anticoagulant

FU:

Follow-up

IASD:

Iatrogenic atrial septal defect

LA:

Left atrium

LVEF:

Left ventricle ejection fraction

PFO:

Patent foramen ovale

PV:

Pulmonary vein

PVI:

Pulmonary vein isolation

RF:

Radiofrequency

TEE:

Transoesophageal echocardiography

TIA:

Transient ischaemic attack

TS:

Transseptal

TSP:

Transseptal puncture

References

  1. Obel O, Mansour M, Picard M, Ruskin J, Keane D. Persistence of septal defects after transeptal puncture for pulmonary vein isolation procedures. Pacing Clin Electrophysiol : PACE. 2004;27(10):1411–4. https://doi.org/10.1111/j.1540-8159.2004.00646.x.

    Article  PubMed  Google Scholar 

  2. Hammerstingl C, Lickfett L, Jeong KM, Troatz C, Wedekind JA, Tiemann K, et al. Persistence of iatrogenic atrial septal defect after pulmonary vein isolation--an underestimated risk? Am Heart J. 2006;152(2):362 e1–5. https://doi.org/10.1016/j.ahj.2006.04.034.

    Article  Google Scholar 

  3. McGinty PM, Smith TW, Rogers JH. Transseptal left heart catheterization and the incidence of persistent iatrogenic atrial septal defects. J Interv Cardiol. 2011;24(3):254–63. https://doi.org/10.1111/j.1540-8183.2011.00630.x.

    Article  PubMed  Google Scholar 

  4. 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. https://doi.org/10.1016/j.ijcard.2017.02.009.

    Article  PubMed  Google Scholar 

  5. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. Focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. Europace. 2012;14(10):1385–413. https://doi.org/10.1093/europace/eus305.

  6. Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, et al. Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr. 2015;28(8):910–58. https://doi.org/10.1016/j.echo.2015.05.015.

    Article  PubMed  Google Scholar 

  7. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609–78. https://doi.org/10.1093/europace/euw295.

    Article  PubMed  Google Scholar 

  8. Chierchia GB, Casado-Arroyo R, de Asmundis C, Rodriguez-Manero M, Sarkozy A, Conte G, et al. Impact of transseptal puncture site on acute and mid-term outcomes during cryoballoon ablation: a comparison between anterior, medial and posterior transatrial access. Int J Cardiol. 2013;168(4):4098–102. https://doi.org/10.1016/j.ijcard.2013.07.079.

    Article  PubMed  Google Scholar 

  9. Lehrmann H, Schneider J, Jadidi AS, Park CI, Schiebeling-Romer J, Allgeier J, et al. Transseptal access for left atrial ablation: the catheter-probing techniques are not without risk. J Cardiovasc Electrophysiol. 2014;25(5):479–84. https://doi.org/10.1111/jce.12356.

    Article  PubMed  Google Scholar 

  10. Mugnai G, Sieira J, Ciconte G, Hervas MS, Irfan G, Saitoh Y, et al. One year incidence of atrial septal defect after PV isolation: a comparison between conventional radiofrequency and cryoballoon ablation. Pacing Clin Electrophysiol : PACE. 2015;38(9):1049–57. https://doi.org/10.1111/pace.12663.

    Article  PubMed  Google Scholar 

  11. Anselmino M, Scaglione M, Battaglia A, Muccioli S, Sardi D, Azzaro G, et al. Iatrogenic atrial septal defects following atrial fibrillation transcatheter ablation: a relevant entity? Europace. 2014;16(11):1562–8. https://doi.org/10.1093/europace/euu020.

  12. Chan NY, Choy CC, Lau CL, Lo YK, Chu PS, Yuen HC, et al. Persistent iatrogenic atrial septal defect after pulmonary vein isolation by cryoballoon: an under-recognized complication. Europace. 2011;13(10):1406–10. https://doi.org/10.1093/europace/eur138.

  13. Sieira J, Chierchia GB, Di Giovanni G, Conte G, De Asmundis C, Sarkozy A, et al. One year incidence of iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25(1):11–5. https://doi.org/10.1111/jce.12279.

    Article  PubMed  Google Scholar 

  14. 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. 2017;48(1):99–103. https://doi.org/10.1007/s10840-016-0193-7.

    Article  PubMed  Google Scholar 

  15. Linhart M, Werner JT, Stockigt F, Kohlmann AT, Lodde PC, Linneborn LPT, et al. High rate of persistent iatrogenic atrial septal defect after single transseptal puncture for cryoballoon pulmonary vein isolation. J Interv Card Electrophysiol. 2018. https://doi.org/10.1007/s10840-018-0352-0.

  16. Watanabe T, Miyazaki S, Kajiyama T, Ichijo S, Takagi T, Igarashi M, et al. Persistence of an iatrogenic atrial septal defect after a second-generation cryoballoon ablation of atrial fibrillation. Heart Vessel. 2018. https://doi.org/10.1007/s00380-018-1147-z.

  17. 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(12):905–12. https://doi.org/10.1080/14779072.2017.1408411.

    Article  CAS  PubMed  Google Scholar 

  18. Aznaouridis K, Hobson N, Rigg C, Bragadeesh T. Emergency percutaneous closure of an iatrogenic atrial septal defect causing right-to-left shunt and severe refractory hypoxemia after pulmonary vein isolation. JACC Cardiovasc Interv. 2015;8(11):e179–81. https://doi.org/10.1016/j.jcin.2015.04.023.

    Article  PubMed  Google Scholar 

  19. Naksuk N, Asirvatham SJ. Iatrogenic atrial septal defect: reassurance or inquisitiveness. J Interv Card Electrophysiol. 2018. https://doi.org/10.1007/s10840-018-0369-4.

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Acknowledgements

We thank Tamás Ferenci PhD for his valuable contribution to the paper.

Funding

The study was supported by EFOP-3.6.3-VEKOP-16-2017-00009 grant.

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Authors and Affiliations

  1. Department of Cardiology, Gottsegen Gyorgy Hungarian Institute of Cardiology, Haller Street 29, Budapest, 1096, Hungary

    Zsofia Nagy, Zsuzsanna Kis, Tamás Géczy, Andras Temesvari, Zoltan Som, Sarolta Borbas, Tamás Breuer, Csaba Foldesi & Attila Kardos

  2. Department of Internal Medicine, Peterfy Sandor Hospital, Peterfy Sandor Street 8-20, Budapest, 1076, Hungary

    David Molnar

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  1. Zsofia Nagy
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  2. Zsuzsanna Kis
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Correspondence to Zsofia Nagy.

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This study was approved the Ethics Committee of the Investigation Centre. Informed consent was obtained from all individual participants included in the study.

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Nagy, Z., Kis, Z., Géczy, T. et al. Prospective evaluation of iatrogenic atrial septal defect after cryoballoon or radiofrequency catheter ablation of atrial fibrillation—“EVITA” study. J Interv Card Electrophysiol 56, 19–27 (2019). https://doi.org/10.1007/s10840-019-00598-9

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