title: Persistent iatrogenic atrial septal defect after pulmonary vein isolation : incidence and clinical implications.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) is widely practiced for treating atrial fibrillation. Transseptal access is necessary with one or even more transseptal sheaths to perform PVI.
  
  
  METHODS
  In this prospective study, 31 patients were examined with transesophageal echocardiography before, immediately after and in a 3-, 6- and 12-month follow-up period for evaluation of iatrogenic atrial septal defect (iASD). All patients underwent PVI with double transseptal puncture.
  
  
  RESULTS
  An iASD was detected in 27/31 patients (87%) with a maximum diameter of 1.0 mm. After 3 months, the iASDs were completely closed in 26/27 (96.3%) patients. In 1/27 (3.7%) patients, there was an iASD detectable even after 12 months. Clinically no patient suffered from cerebral or cardiac embolism in the follow-up period.
  
  
  CONCLUSIONS
  We were only able to find small iASDs with left to right shunting after PVI but none with right to left shunting. iASDs following PVI show a high spontaneous closure rate already at 3 months of follow-up and are not associated with an increased rate of paradoxical embolism.
authors.affiliation: Department of Cardiology, Academic Hospital of the University of Freiburg, Freiburg, Germany. arillig5@yahoo.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.forename: Udo
authors.initials: U
authors.lastname: Meyerfeldt
authors.forename: Ralf
authors.initials: R
authors.lastname: Birkemeyer
authors.forename: Fabian
authors.initials: F
authors.lastname: Treusch
authors.forename: Markus
authors.initials: M
authors.lastname: Kunze
authors.forename: Werner
authors.initials: W
authors.lastname: Jung
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*