title: Transcatheter closure of atrial septal defect in elderly patients with permanent atrial fibrillation.
abstract: OBJECTIVE
  The aim of this study is to evaluate the feasibility and efficacy of device closure of atrial septal defect (ASD) in elderly patients with permanent atrial fibrillation.
  
  
  BACKGROUND
  Little is known about the feasibility of device closure of ASD in those patients.
  
  
  METHODS
  Nine consecutive patients (mean age 68.1 years) with permanent atrial fibrillation (>1 year persistent) underwent catheter closure using the Amplatzer septal occluder. Transthoracic echocardiography and plasma B-type natriuretic peptide (BNP) level were assessed before and at 24 hours; and 1, 3, and >6 months after the closure. Before the procedure, appropriate dose of warfarin was used in all, diuretics was used in 8/9. Same amount of medications were continued after the procedure.
  
  
  RESULTS
  ASD could be closed in all (mean device size 27.3 mm) without hemodynamic and thromboembolic complications. New York Heart Association (NYHA) functional classification was significantly improved in all patients after device closure. No hemodynamic and thromboembolic complications were observed during the follow-up period (mean 10.6 months). Although permanent atrial fibrillation did not change in all after the procedure, resting heart rate decreased from 76.2 +/- 16.0 to 68.3 +/- 13.2 beats/min (P = 0.015). There was statistically significant improvement in right ventricular/left ventricular diameter ratio (1.08 +/- 0.16 to 0.73 +/- 0.10, P = 0.008) and plasma BNP level (183.7 +/- 90.5 to 94.6 +/- 47.4 pg/mL, P = 0.008) after >6 months device closure.
  
  
  CONCLUSIONS
  Even in the patients complicated with permanent fibrillation, transcatheter closure of ASD can contribute to symptomatic improvement as well as cardiac geometric remodeling.
authors.affiliation: Division of Cardiac Care Unit, Okayama University Hospital, Okayama, Japan. tmnb@md.okayama-u.ac.jp
authors.forename: Manabu
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Teiji
authors.initials: T
authors.lastname: Akagi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ohtsuki
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tanabe
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Watanabe
authors.forename: Koji
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Norihisa
authors.initials: N
authors.lastname: Toh
authors.forename: Kengo
authors.initials: K
authors.lastname: Kusano
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000295:instrumentation; D004232:Diuretics / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D004232:Diuretics; D020097:Natriuretic Peptide, Brain; D014859:Warfarin