https://doi.org/10.1007/s00392-024-02526-y
1Herz- und Diabeteszentrum NRW Klinik für Elektrophysiologie/ Rhythmologie Bad Oeynhausen, Deutschland; 2Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland; 3Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland
Introduction:
Transseptal puncture (TSP) is an essential step in the interventional treatment of atrial fibrillation. Patients who have received an atrial septal occluder (ASO) due to an atrial septal defect (ASD) or a persistent foramen ovale (PFO) represent a special cohort in this context. The development of safe and effective techniques for TSP in this patient group is of great importance to ensure successful ablation.
Objectives:
The aim of this study was to investigate the peri- and post-procedural safety of patients after atrial fibrillation ablation as well as the recurrence of atrial fibrillation or a newly developed ASD/PFO up to 12 months post-procedurally.
Material and methods:
A total of 33 patients were included in this monocentric, retrospective observational study between 2019 and 2024 who suffered from drug-refractory atrial fibrillation and were treated interventionally using pulmonary vein isolation (PVI). Of these, 23 patients had an ASD and 10 patients had a PFO. All patients already had an ASO in situ at the time of ablation.
Results:
A total of 33 patients (mean age 62±11 years, 61% male) with 64% persistent AF and an average CHA2DS2-VASc score of 2±1.4 points were retrospectively analyzed. An average of 8.5 years (range: 1-22 years) had passed between the implantation of an ASO and the need to perform a PVI. All punctures (single TSP) were performed under fluoroscopic guidance. The majority of TSP-position on IAS were inferior-posterior 69.7%, n=23 and inferior-anterior 21.2%, n=7 and in the case of failure of the inferior part, then it was performed in superior-posterior 9.1%, n=3 (Figure 1). The average procedure time was 89.64±22.69 minutes, the ablation time was 14.7±8.2 minutes and the fluoroscopy time was 6.0±5.7 minutes. Furthermore, the periprocedurally created voltage map showed no additional relevant substrate for ablation related to the occluder. An increased rate of atrial fibrillation recurrence was not documented in this cohort. During a mean follow-up of 27 months, 4 patients showed recurrence of atrial fibrillation. No periprocedural complications were documented in any patient. Complications with the occluder did not occur, in particular no relevant shunt could be detected in the area of the puncture site or the device.
Conclusion:
TSP and PVI are safe and can be successfully performed in patients with an ASO with fluoroscopic guidance. In particular, none of the patients experienced peri- or post-procedural complications or a relevant shunt in the area of the device or the puncture site as well as no additional relevant substrate related to the occluder. Further studies are needed to validate these initial observations.
Figure1:
TSP position in relationship to ASO in patients underwent PVI as well as a voltage map of LA after PVI showing no extra substrate associated to ASO.