Araştırma Makalesi
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Persistent iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation

Yıl 2024, , 118 - 123, 30.04.2024
https://doi.org/10.47582/jompac.1446976

Öz

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.

Kaynakça

  • 1. Nielsen JC, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. New Eng J Med. 2012;367(17):1587-1595. doi: 10.1056/nejmoa1113566
  • 2. Yoshida K, Yoshikawa J, Akasaka T, et al. Assessment of left-to-right atrial shunting after percutaneous mitral valvuloplasty by transesophageal color Doppler flow-mapping. Circulation. 1989;80(6):1521-1526.
  • 3. Packer DL, Kowal RC, Wheelan KR, et al. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American arctic front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013;61(16):1713-1723. doi: 10.1016/j.jacc.2012.11.064
  • 4. Neumann T, Vogt J, Schumacher B, et al. Circumferential pulmonary vein isolation with the cryoballoon technique. Results from a prospective 3-center study. J Am Coll Cardiol. 2008;52(4):273-278. doi: 10.1016/j.jacc.2008.04.021
  • 5. Hausmann D, Daniel WG, Mugge A, Ziemer G, Pearlman AS. Value of transesophageal color doppler echocardiography for detection of different types of atrial septal defect in adults. J Am Soc Echocardiograp. 1992;5(5):481-488. doi: 10.1016/S0894-7317(14)80039-4
  • 6. Ishikura F, Nagata S, Yasuda S, Yamashita N, Miyatake K. Residual atrial septal perforation after percutaneous transvenous mitral commissurotomy with inoue balloon catheter. Am Heart J. 1990;120(4):873-878. doi: 10.1016/0002-8703(90)90203-A
  • 7. Watanabe T, Miyazaki S, Kajiyama T, et al. Persistence of an iatrogenic atrial septal defect after a second-generation cryoballoon ablation of atrial fibrillation. Heart Vessels. 2018;33(9):1060-1067. doi: 10.1007/s00380-018-1147-z
  • 8. Cronin EM, Collier P, Wazni OM, Griffin BP, Jaber WA, Saliba WI. Persistence of atrial septal defect after cryoballoon ablation of atrial fibrillation. J Am Coll Cardiol, 2013;62(16):1491-1492. doi: 10.1016/J.JACC.2013.07.017
  • 9. Fraker Jr TD, Harris PJ, Behar VS, Kisslo JA. Detection and exclusion of interatrial shunts by two-dimensional echocardiography and peripheral venous injection. Circulation. 1979;59(2):379-384. doi: 10.1161/01.CIR.59.2.379
  • 10. Soliman OI, Geleijnse ML, Meijboom FJ, et al. The use of contrast echocardiography for the detection of cardiac shunts. Eur J Echocardiograp. 2007;8(3):s2-s12. doi: 10.1016/j.euje.2007.03.006
  • 11. Fitchet A, Turkie W, Fitzpatrick AP. Transeptal approach to ablation of left‐sided arrhythmias does not lead to persisting interatrial shunt: a transesophageal echocardiographic study. Pacing Clin Electrophysiol. 1998;21(11):2070-2072. doi: 10.1111/j.1540-8159.1998.tb01125.x
  • 12. Hammerstingl C, Lickfett L, Jeong KM, et al. Persistence of iatrogenic atrial septal defect after pulmonary vein isolation-an underestimated risk? Am Heart J. 2006;152(2):362.e1-362.e5. doi: 10.1016/j.ahj.2006.04.034
  • 13. Rillig A, Meyerfeldt U, Birkemeyer R, Treusch F, Kunze M, Jung W. Persistent iatrogenic atrial septal defect after pulmonary vein isolation. J Intervent Cardiac Electrophysiol. 2008;22(3):177-181. doi: 10.1007/s10840-008-9257-7
  • 14. Mugnai G, Sieira J, Ciconte G, et al., One year incidence of atrial septal defect after PV isolation: a comparison between conventional radiofrequency and cryoballoon ablation. Pacing Clin Electrophysiol. 2015;38(9):1049-1057. doi: 10.1111/pace.12663
  • 15. Yang Y, Wu J, Yao L, et al. The influence of iatrogenic atrial septal defect on the prognosis of patients with atrial fibrillation between cryoablation and radiofrequency ablation. Biosci Rep. 2020;40(2):BSR20193128. doi: 10.1042/BSR20193128
  • 16. Schueler R, Öztürk C, Wedekind JA, et al. Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the mitraclip system: a note of caution. JACC Cardiovasc Interv. 2015;8(3):450-459. doi: 10.1016/J.JCIN.2014.10.024
  • 17. Singh SM, Douglas PS, Reddy VY. The incidence and long-term clinical outcome of iatrogenic atrial septal defects secondary to transseptal catheterization with a 12F transseptal sheath. Circ Arrhythm Electrophysiol. 2011;4(2):166-171. doi: 10.1161/CIRCEP.110.959015
  • 18. Rillig A, Meyerfeldt U, Kunze M, et al. Persistent iatrogenic atrial septal defect after a single-puncture, double-transseptal approach for pulmonary vein isolation using a remote robotic navigation system: results from a prospective study. Europace. 2010;12(3):331-336. doi: 10.1093/europace/eup428
  • 19. Chan NY, Choy CC, Lau CL, et al. Persistent iatrogenic atrial septal defect after pulmonary vein isolation by cryoballoon: an under-recognized complication. Europace. 2011;13(10):1406-1410. doi: 10.1093/europace/eur138
  • 20. Sieira J, Chierchia GB, Di Giovanni G, et al. One year incidence of iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25(1):11-15. doi: 10.1111/jce.12279
  • 21. 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. Canadian J Cardiol. 2019;35(4):396-404. doi: 10.1016/j.cjca.2018.12.028
  • 22. 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 Intervent Cardiac Electrophysiol. 2017; 48(1):99-103. doi: 10.1007/s10840-016-0193-7
  • 23. Linhart M, Werner JT, Stöckigt F, et al., High rate of persistent iatrogenic atrial septal defect after single transseptal puncture for cryoballoon pulmonary vein isolation. J Intervent Cardiac Electrophysiol. 2018;52(2):141-148. doi: 10.1007/s10840-018-0352-0
  • 24. Deshmukh A, Patel NJ, Pant S, et al., In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation. 2013;128(19):2104-2112. doi: 10.1161/CIRCULATIONAHA.113.003862
  • 25. Wu LA, Malouf JF, Dearani JA, et al. Patent foramen ovale in cryptogenic stroke. Arch Intern Med. 2004;164(9):950. doi: 10.1001/archinte.164.9.950
  • 26. Baumgartner H, Bonhoeffer P, De Groot NMS, et al. ESC guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010;31(23):2915-2957. doi: 10.1093/eurheartj/ehq249
  • 27. Herrera Siklódy C, Deneke T, Hocini M, et al. Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study. J Am Coll Cardiol. 2011;58(7):681-688. doi: 10.1016/J.JACC.2011.04.010

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

Yıl 2024, , 118 - 123, 30.04.2024
https://doi.org/10.47582/jompac.1446976

Öz

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.

Kaynakça

  • 1. Nielsen JC, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. New Eng J Med. 2012;367(17):1587-1595. doi: 10.1056/nejmoa1113566
  • 2. Yoshida K, Yoshikawa J, Akasaka T, et al. Assessment of left-to-right atrial shunting after percutaneous mitral valvuloplasty by transesophageal color Doppler flow-mapping. Circulation. 1989;80(6):1521-1526.
  • 3. Packer DL, Kowal RC, Wheelan KR, et al. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American arctic front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013;61(16):1713-1723. doi: 10.1016/j.jacc.2012.11.064
  • 4. Neumann T, Vogt J, Schumacher B, et al. Circumferential pulmonary vein isolation with the cryoballoon technique. Results from a prospective 3-center study. J Am Coll Cardiol. 2008;52(4):273-278. doi: 10.1016/j.jacc.2008.04.021
  • 5. Hausmann D, Daniel WG, Mugge A, Ziemer G, Pearlman AS. Value of transesophageal color doppler echocardiography for detection of different types of atrial septal defect in adults. J Am Soc Echocardiograp. 1992;5(5):481-488. doi: 10.1016/S0894-7317(14)80039-4
  • 6. Ishikura F, Nagata S, Yasuda S, Yamashita N, Miyatake K. Residual atrial septal perforation after percutaneous transvenous mitral commissurotomy with inoue balloon catheter. Am Heart J. 1990;120(4):873-878. doi: 10.1016/0002-8703(90)90203-A
  • 7. Watanabe T, Miyazaki S, Kajiyama T, et al. Persistence of an iatrogenic atrial septal defect after a second-generation cryoballoon ablation of atrial fibrillation. Heart Vessels. 2018;33(9):1060-1067. doi: 10.1007/s00380-018-1147-z
  • 8. Cronin EM, Collier P, Wazni OM, Griffin BP, Jaber WA, Saliba WI. Persistence of atrial septal defect after cryoballoon ablation of atrial fibrillation. J Am Coll Cardiol, 2013;62(16):1491-1492. doi: 10.1016/J.JACC.2013.07.017
  • 9. Fraker Jr TD, Harris PJ, Behar VS, Kisslo JA. Detection and exclusion of interatrial shunts by two-dimensional echocardiography and peripheral venous injection. Circulation. 1979;59(2):379-384. doi: 10.1161/01.CIR.59.2.379
  • 10. Soliman OI, Geleijnse ML, Meijboom FJ, et al. The use of contrast echocardiography for the detection of cardiac shunts. Eur J Echocardiograp. 2007;8(3):s2-s12. doi: 10.1016/j.euje.2007.03.006
  • 11. Fitchet A, Turkie W, Fitzpatrick AP. Transeptal approach to ablation of left‐sided arrhythmias does not lead to persisting interatrial shunt: a transesophageal echocardiographic study. Pacing Clin Electrophysiol. 1998;21(11):2070-2072. doi: 10.1111/j.1540-8159.1998.tb01125.x
  • 12. Hammerstingl C, Lickfett L, Jeong KM, et al. Persistence of iatrogenic atrial septal defect after pulmonary vein isolation-an underestimated risk? Am Heart J. 2006;152(2):362.e1-362.e5. doi: 10.1016/j.ahj.2006.04.034
  • 13. Rillig A, Meyerfeldt U, Birkemeyer R, Treusch F, Kunze M, Jung W. Persistent iatrogenic atrial septal defect after pulmonary vein isolation. J Intervent Cardiac Electrophysiol. 2008;22(3):177-181. doi: 10.1007/s10840-008-9257-7
  • 14. Mugnai G, Sieira J, Ciconte G, et al., One year incidence of atrial septal defect after PV isolation: a comparison between conventional radiofrequency and cryoballoon ablation. Pacing Clin Electrophysiol. 2015;38(9):1049-1057. doi: 10.1111/pace.12663
  • 15. Yang Y, Wu J, Yao L, et al. The influence of iatrogenic atrial septal defect on the prognosis of patients with atrial fibrillation between cryoablation and radiofrequency ablation. Biosci Rep. 2020;40(2):BSR20193128. doi: 10.1042/BSR20193128
  • 16. Schueler R, Öztürk C, Wedekind JA, et al. Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the mitraclip system: a note of caution. JACC Cardiovasc Interv. 2015;8(3):450-459. doi: 10.1016/J.JCIN.2014.10.024
  • 17. Singh SM, Douglas PS, Reddy VY. The incidence and long-term clinical outcome of iatrogenic atrial septal defects secondary to transseptal catheterization with a 12F transseptal sheath. Circ Arrhythm Electrophysiol. 2011;4(2):166-171. doi: 10.1161/CIRCEP.110.959015
  • 18. Rillig A, Meyerfeldt U, Kunze M, et al. Persistent iatrogenic atrial septal defect after a single-puncture, double-transseptal approach for pulmonary vein isolation using a remote robotic navigation system: results from a prospective study. Europace. 2010;12(3):331-336. doi: 10.1093/europace/eup428
  • 19. Chan NY, Choy CC, Lau CL, et al. Persistent iatrogenic atrial septal defect after pulmonary vein isolation by cryoballoon: an under-recognized complication. Europace. 2011;13(10):1406-1410. doi: 10.1093/europace/eur138
  • 20. Sieira J, Chierchia GB, Di Giovanni G, et al. One year incidence of iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25(1):11-15. doi: 10.1111/jce.12279
  • 21. 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. Canadian J Cardiol. 2019;35(4):396-404. doi: 10.1016/j.cjca.2018.12.028
  • 22. 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 Intervent Cardiac Electrophysiol. 2017; 48(1):99-103. doi: 10.1007/s10840-016-0193-7
  • 23. Linhart M, Werner JT, Stöckigt F, et al., High rate of persistent iatrogenic atrial septal defect after single transseptal puncture for cryoballoon pulmonary vein isolation. J Intervent Cardiac Electrophysiol. 2018;52(2):141-148. doi: 10.1007/s10840-018-0352-0
  • 24. Deshmukh A, Patel NJ, Pant S, et al., In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation. 2013;128(19):2104-2112. doi: 10.1161/CIRCULATIONAHA.113.003862
  • 25. Wu LA, Malouf JF, Dearani JA, et al. Patent foramen ovale in cryptogenic stroke. Arch Intern Med. 2004;164(9):950. doi: 10.1001/archinte.164.9.950
  • 26. Baumgartner H, Bonhoeffer P, De Groot NMS, et al. ESC guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010;31(23):2915-2957. doi: 10.1093/eurheartj/ehq249
  • 27. Herrera Siklódy C, Deneke T, Hocini M, et al. Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study. J Am Coll Cardiol. 2011;58(7):681-688. doi: 10.1016/J.JACC.2011.04.010
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kardiyoloji
Bölüm Research Articles [en] Araştırma Makaleleri [tr]
Yazarlar

Görkem Yıldız 0000-0001-6750-2601

Başar Candemır 0000-0003-2657-7601

Demet Menekse Gerede 0000-0002-8552-0691

Yayımlanma Tarihi 30 Nisan 2024
Gönderilme Tarihi 4 Mart 2024
Kabul Tarihi 22 Nisan 2024
Yayımlandığı Sayı Yıl 2024

Kaynak Göster

AMA Yıldız G, Candemır B, Gerede DM. Persistent iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation. J Med Palliat Care / JOMPAC / Jompac. Nisan 2024;5(2):118-123. doi:10.47582/jompac.1446976

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