Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair: a feasibility, safety, and efficacy study.
Intracardiac Echo-Guided Radiofrequency Catheter.


BACKGROUND
Patients with atrial septal defect (ASD) are at higher risk for atrial fibrillation (AF) even after repair. Transseptal access in these patients is perceived to be difficult. We describe the feasibility, safety, and efficacy of pulmonary vein antral isolation (PVAI) in these patients.


METHODS
We prospectively compared post-ASD/patent foramen ovale (PFO) repair patients (group I, n = 45) with age-gender-AF type matched controls (group II, n = 45). All the patients underwent PVAI through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography (ICE). The short-term (3 months) and long-term (12 month) failure rates were assessed.


RESULTS
In group I, 23 (51%) had percutaneous closure devices and 22 (49%) had a surgical closure. There was no significant difference between group I and II in the baseline characteristics. Intracardiac echo-guided double transseptal access was obtained in 98% of patients in group I and in 100% of patients in group II. PVAI was performed in all patients, with right atrial flutter ablation in 7 patients in group I and in 4 patients in group II. Over a mean follow-up of 15 +/- 4 months, group I had higher short-term (18% vs 13%, P = 0.77) and long-term recurrence (24% vs 18%, P = 0.6) than group II. There was no significant difference in the perioperative complications between the two groups. Echocardiography at 3 months showed interatrial communication in 2 patients in group I and 1 patient in group II, which resolved at 12 months.


CONCLUSIONS
Percutaneous AF ablation using double transseptal access is feasible, safe, and efficacious in patients with ASD and PFO repairs.
Lakkireddy
Dhanunjaya
D
Mid-America Cardiology at the University of Kansas Hospital, Kansas City, Kansas, USA.
Rangisetty
Umamahesh
U
Prasad
Subramanya
S
Verma
Atul
A
Biria
Mazda
M
Berenbom
Loren
L
Pimentel
Rhea
R
Emert
Martin
M
Rosamond
Thomas
T
Fahmy
Tamer
T
Patel
Dimpi
D
Di Biase
Luigi
L
Schweikert
Robert
R
Burkhardt
David
D
Natale
Andrea
A
D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D018570:Risk Assessment; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography