Persistent iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation

Abstract

Aims: Pulmonary vein isolation (PVI) by cryoballoon ablation (CB) technology is effective and safe treatment option for atrial fibrillation (AF). CB is performed by large diameter, 15Fr (4.95mm) transseptal sheath that may lead to creation of iatrogenic atrial septal defect (iASD). The objective of this study was to assess the incidence of iASD in patients who had undergone CB. Methods: Patients with AF having undergone Arctic Front® CB ablation and a subsequent transesophageal echocardiography (TEE) examination during post-ablation follow up period were consecutively enrolled. During all CB procedures, 15Fr transseptal sheath (Flex Cath, Medtronic, Minneapolis, MN) was utilized via single transseptal puncture (TsP). Results: Twenty-eight patients (15 females, mean age 55.8+15.5) with paroxysmal (n=24) or persistent (n=4) AF formed study group. iASD was present 11 (39.3%) of them after mean follow-up time of 17.3+6.2 months. The procedural time is significantly longer in patient with iASD (119.0+8.8 minutes, p=0.01). No patients died or suffered from any clinically significant cerebral ischemic event. There was no sign of increase in systolic pulmonary arterial pressure (sPAP). Conclusion: iASD after CB was found to be present in 39.3% of patient during a mean follow-up time of 17.3+6.2 months. The prolonged CB procedural time was the only factor that predicted iASD in our study. No adverse clinic events that might be related to iASD was observed during follow-up period.

Keywords

• Iatrogenic atrial septal defect
• cryoballoon ablation
• pulmonary vein isolation
• atrial fibrillation

Atriyal fibrilasyon kriyobalon ablasyon tedavisi uygulanan hastalarda kalıcı iyatrojenik atriyal septal defekt

Abstract

Amaç: Paroksismal atriyal fibrilasyon (AF) tedavisinde pulmoner ven izolasyon (PVI) yöntemlerinden olan kriyobalon (KB) ablasyonun güvenilir ve etkin olduğu bilinmektedir. KB işlemi, 15Fr (4.95mm) çaplı transseptal kılıf (TS) kullanılması nedeni ile iyatrojenik atriyal septal defekt (iASD) riski taşımaktadır. Çalışmamızın amacı, KB tekniği ile PVI uygulanan hastalarda iASD varlığının araştırılmasıdır. Yöntem: Arctic Front® KB sistemi kullanılarak PVI uygulanan hastalardan işlem öncesinde ve işlemden 3 ay veya daha sonrasında transozefageal ekokardiyografisi (TOE) yapılmış olanlar çalışmaya dâhil edilmiştir. Hastaların hepsinde KB işlemi sırasında tek ponksiyon yapılmış ve 15Fr TS kılıf (Flexcath, Medtronic, Minneapolis, MN) kullanılmıştır. İşlem sonrası TOE’ lerinde iASD olup olmadığı incelenmiştir. Bulgular: 15’i kadın (%54) ve 13’ü erkek (%46) toplam 28 hastanın 4’ünde persistan (%14), 24’ünde paroksismal (%86) AF mevcuttur. Yaş ortalaması 55.8+15.5 yıldır. Ortalama 17.3+6.2 ay sonra yapılan TOE’lerde iASD, 11 (%39.3) hastada tespit edilmiştir. KB işleminin ortalama süresi, iASD tespit edilen grupta (119.0+8.8 dk), iASD olmayan gruptakine (92.9+21.0 dk) göre anlamlı olarak daha uzun tespit edilmiştir (p=0.01). Takip süresinde serebral iskemik olay veya pulmoner arter basıncında anlamlı artış izlenmemiştir. Sonuç: Çalışmamızda KB işlemi sonrası iASD oranı (%39.3) yüksek tespit edilmiştir. Takip süresinde iASD bağlı olabilecek komplikasyon izlenmemiştir. iASD gelişimini öngördüren tek faktör KB işleminin süresidir.

Keywords

• İyatrojenik atriyal septal defekt
• kriyobalon ablasyon
• pulmoner ven izolasyon
• atriyal fibrilasyon

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