title: Iatrogenic atrial septal defects following atrial fibrillation transcatheter ablation: a relevant entity?
abstract: OBJECTIVE
  The previous literature has suggested that the iatrogenic atrial septal defects (IASDs) may follow left atrial (LA) access by transseptal (TS) puncture, especially in the case of a single TS for more than one catheter. The aim of the present study is to describe the prevalence of patent foramen ovale (PFO) and IASDs in a cohort of atrial fibrillation (AF) patients undergoing redo catheter ablation (CA) procedures in a high-volume centre accessing LA by a standardized single TS puncture.
  
  
  RESULTS
  Patients (n = 197) who underwent at least one redo AFCA, between 2004 and 2012, were retrospectively enroled. Transoesophageal echocardiography was performed before each procedure during which LA was accessed via a PFO, if present, or by single TS for both the mapping and ablation catheters. At baseline, PFO was detected in 43 (21.8%) patients. Clinical and echocardiographic parameters recorded did not differ within patients presenting with or without PFO. Left atrium was accessed via PFO in 39 (90.7% of those with PFO) patients during the first procedure. New-onset IASD occurred in 11 (5.6%) patients following the first procedure and in 1 (2.2%) patient following the second procedure. The clinical and echocardiographic parameters did not differ within the patients irrespective of whether IASD was reported or not. No TS-related complications occurred.
  
  
  CONCLUSIONS
  In the present cohort, LA access by PFO or single TS for both the mapping and ablation catheters lead to a small risk of asymptomatic IASD, not increased by redo procedures, confirming that it represents a safe approach. No clinical and/or echocardiographic parameters seemed to predict IASD occurrence.
authors.affiliation: Cardiology Division, Department of Internal Medicine, University of Turin, 10126 Turin, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.affiliation: Division of Cardiology, Cardinal Guglielmo Massaia Hospital, 14100 Asti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.affiliation: Cardiology Division, Department of Internal Medicine, University of Turin, 10126 Turin, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Battaglia
authors.affiliation: Cardiology Division, Department of Internal Medicine, University of Turin, 10126 Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Muccioli
authors.affiliation: Division of Cardiology, Cardinal Guglielmo Massaia Hospital, 14100 Asti, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Sardi
authors.affiliation: Division of Cardiology, Cardinal Guglielmo Massaia Hospital, 14100 Asti, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Azzaro
authors.affiliation: Cardiology Division, Department of Internal Medicine, University of Turin, 10126 Turin, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Garberoglio
authors.affiliation: Division of Cardiology, Cardinal Guglielmo Massaia Hospital, 14100 Asti, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Miceli
authors.affiliation: Cardiology Division, Department of Internal Medicine, University of Turin, 10126 Turin, Italy gaitaf@gmail.it fiorenzo.gaita@unito.it.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D054087:Atrial Septum / Q000000981:diagnostic imaging / Q000293:injuries*; D017115:Catheter Ablation / Q000009:adverse effects*; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000453:epidemiology*; D061847:Hospitals, High-Volume; D006801:Humans; D007049:Iatrogenic Disease; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011677:Punctures / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Ablation; Atrial fibrillation; Iatrogenic atrial septal defects; Patent foramen ovale; Transseptal puncture