title: 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.
abstract: OBJECTIVE
  Persistent iatrogenic atrial septal defect (iASD) after transseptal puncture for pulmonary vein isolation (PVI) has been described recently as a complication of PVI. No data exists evaluating systematically the incidence and clinical implications of iASDs after PVI using a remote robotic navigation system (RNS) with sheaths with a distinct larger outer diameter.
  
  
  RESULTS
  In this prospective study, 40 patients with either paroxysmal (n = 22, 55%) or persistent symptomatic atrial fibrillation were treated with circumferential PVI using an RNS. In all patients, a single-puncture, double-transseptal approach was used to access the left atrium. Transoesophageal echocardiography was performed before and the day after PVI as well as after a 3 and 6 months follow-up (FU). The day after ablation an iASD was detected in 38 of 40 (95%) patients with a mean diameter of 3.45 +/- 1.5 mm. At 6-month FU, the iASDs were closed in 30 of 39 (78.9%) patients. During the 6-month FU period, no patient died or suffered from cerebral or cardiac embolism.
  
  
  CONCLUSIONS
  After a single-puncture, double-transseptal approach for PVI using the RNS, iASDs show a high spontaneous closure rate of 78.9% after a 6-month FU period. Persistent iASDs following PVI with the RNS are not associated with an increased rate of paradoxical embolism or with relevant shunting.
authors.affiliation: Department of Cardiology, Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Academic Hospital of the University of Freiburg Vöhrenbacherstr, 23, Villingen-Schwenningen, Germany. arillig5@yahoo.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.forename: Udo
authors.initials: U
authors.lastname: Meyerfeldt
authors.forename: Markus
authors.initials: M
authors.lastname: Kunze
authors.forename: Ralf
authors.initials: R
authors.lastname: Birkemeyer
authors.forename: Tomislav
authors.initials: T
authors.lastname: Miljak
authors.forename: Sebastian
authors.initials: S
authors.lastname: Jäckle
authors.forename: Bajram
authors.initials: B
authors.lastname: Hajredini
authors.forename: Fabian
authors.initials: F
authors.lastname: Treusch
authors.forename: Werner
authors.initials: W
authors.lastname: Jung
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000706:statistics & numerical data; D016896:Treatment Outcome