Abstract 12169: Transseptal Access and Atrial Fibrillation Ablation Guided by Intracardiac Echo in Patients with Atrial Septal Closure Devices
Introduction. Percutaneous positioning of closure devices is a well-established treatment of atrial septal defects (ASD). These patients are at increased risk of developing atrial fibrillation (AF), and treatment by catheter ablation is underutilized due to the perceived difficulty of obtaining transseptal access in the presence of the closure device. We report the acute and long-term results of radiofrequency catheter ablation of AF in patients with ASD closure devices.
Methods. Thirty-nine patients (age 54 ± 6 years, 72% males) with drug-refractory AF (33% paroxysmal, 51% persistent, 16% long-standing persistent) and ASD closure devices (82% Amplatzer®, 18% Cardioseal®) underwent radiofrequency catheter ablation. A double transseptal access guided by intracardiac echocardiography (ICE) was obtained in all patients.
Results. In 35/39 (90%) patients the transseptal access was obtained in a portion of the native septum, while in 4/39 (10%) a direct access through the device was required. The latter group had a significantly longer time for achieving the double transseptal access (73.6 ± 1.1 min vs. 4.3 ± 0.4 min, p < 0.001), longer fluoroscopy time (122 ± 5 min vs. 80 ± 8 min, p < 0.001), and total procedure time (4.1 ± 0.2 hours vs. 3.1 ± 0.3 hours, p < 0.001). At a follow-up of 14 ± 4 months the overall success rate was 77% (85% in paroxysmal AF, 73% in non-paroxysmal AF). Transthoracic contrast-enhanced echocardiography with the Valsalva maneuver, performed between 3 and 6 months after the procedure, failed to detect shunt in all patients.
Conclusions. Radiofrequency catheter ablation of AF is feasible, safe and effective in patients with ASD closure devices. Transseptal access can be obtained in portions of the native septum in the majority of the cases. Direct transseptal puncture of the device is feasible and safe, but it requires longer time for each transseptal access.
- © 2011 by American Heart Association, Inc.