The incidence and long-term clinical outcome of iatrogenic atrial septal defects secondary to transseptal catheterization with a 12F transseptal sheath.
BACKGROUND
Studies assessing the presence of a residual iatrogenic atrial septal defect (iASD) after transseptal catheterization with 8F transseptal sheaths have suggested that the majority of these iASDs close within 6 months. However, these studies have been limited by small patient numbers and short follow-up. Additionally, there are a number of novel catheter procedures in interventional cardiology and electrophysiology that use larger transseptal sheaths. The objective of this study was to assess the incidence of and complications associated with iASDs in a large cohort of patients undergoing transseptal catheterization with a 12F transseptal sheath.


RESULTS
Patients (n=253) without a preexisting interatrial shunt undergoing WATCHMAN implantation as part of the PROTECT AF study were included in this current study. Patients underwent transesophageal echocardiography with echo-contrast immediately after the procedure and at 45 days and 6 months and 12 months. Eighty-seven percent of patients had an iASD immediately after the procedure, the majority of which sealed by 6 months (incidence of iASD, 34% at 45 days, 11% at 6 months, 7% at 12 months). Whereas the majority of iASDs were >3 mm in diameter immediately after the procedure, the minority of iASD were >3 mm during the follow-up period. Additionally, interatrial shunting was predominantly left-to-right when an iASD was present. There was no significant difference in the rate of stroke and/or systemic embolism during the follow-up period in patients with or without iASD.


CONCLUSIONS
Transseptal catheterization procedures with a large-diameter transseptal sheath have a high spontaneous closure rate of iASDs that is not associated with an increased rate of stroke/systemic embolization during long-term follow-up.
Cardiac Arrhythmia Service, Mount Sinai School of Medicine, New York, NY, USA.
Sheldon M
SM
Singh
Pamela S
PS
Douglas
Vivek Y
VY
Reddy
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000628:therapy*; D054087:Atrial Septum / Q000293:injuries; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D057785:Catheters / Q000009:adverse effects*; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors