Concomitant pulmonary vein isolation and percutaneous closure of atrial septal defects: A pilot project.
Atrial Fibrillation
/ diagnosis
Cardiac Catheterization
/ adverse effects
Cryosurgery
/ adverse effects
Feasibility Studies
Female
Heart Septal Defects, Atrial
/ complications
Hemodynamics
Humans
Male
Middle Aged
Pilot Projects
Progression-Free Survival
Pulmonary Veins
/ physiopathology
Recurrence
Risk Factors
Septal Occluder Device
Time Factors
AF
ASD
PVI
percutaneous closure
Journal
Congenital heart disease
ISSN: 1747-0803
Titre abrégé: Congenit Heart Dis
Pays: United States
ID NLM: 101256510
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
12
07
2019
revised:
04
10
2019
accepted:
25
10
2019
pubmed:
7
11
2019
medline:
1
7
2020
entrez:
7
11
2019
Statut:
ppublish
Résumé
Patients with an atrial septal defect (ASD) are at increased risk of developing atrial fibrillation (AF). Currently percutaneous ASD closure is the preferred therapeutic strategy and although pulmonary vein isolation (PVI) for AF is feasible after ASD closure, the transseptal puncture can be technically challenging and probably increases the perioperative risk. A staged approach, with PVI several months before ASD closure, has been recommended for patients already scheduled for closure, but no data are available on combined procedures. This pilot study evaluates the feasibility of a combined procedure of PVI and ASD closure in patients with a hemodynamic important ASD and documented AF. In one procedure, PVI was performed prior to placement of the ASD closure device. Transseptal access for PVI was obtained via wire passage through the ASD in all patients. Patients were followed with 5-day-holter monitoring at 3, 6, and 12 months. Recurrence of AF was defined as a documented, symptomatic episode of AF. The study population consisted of five patients (four females, mean age: 58 (±3) years). Acute PVI was achieved in all patients. Only one patient had a small residual ASD after closure. Besides a small groin hematoma in two patients, no complications occurred. After 12-month follow-up, three patients were free of AF recurrence (60%). This study shows that a combined PVI with ASD closure is feasible with an acceptable success rate of AF free survival. These preliminary results in a small patient group warrants a larger trial.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with an atrial septal defect (ASD) are at increased risk of developing atrial fibrillation (AF). Currently percutaneous ASD closure is the preferred therapeutic strategy and although pulmonary vein isolation (PVI) for AF is feasible after ASD closure, the transseptal puncture can be technically challenging and probably increases the perioperative risk. A staged approach, with PVI several months before ASD closure, has been recommended for patients already scheduled for closure, but no data are available on combined procedures.
PURPOSE
OBJECTIVE
This pilot study evaluates the feasibility of a combined procedure of PVI and ASD closure in patients with a hemodynamic important ASD and documented AF.
METHODS
METHODS
In one procedure, PVI was performed prior to placement of the ASD closure device. Transseptal access for PVI was obtained via wire passage through the ASD in all patients. Patients were followed with 5-day-holter monitoring at 3, 6, and 12 months. Recurrence of AF was defined as a documented, symptomatic episode of AF.
RESULTS
RESULTS
The study population consisted of five patients (four females, mean age: 58 (±3) years). Acute PVI was achieved in all patients. Only one patient had a small residual ASD after closure. Besides a small groin hematoma in two patients, no complications occurred. After 12-month follow-up, three patients were free of AF recurrence (60%).
CONCLUSION
CONCLUSIONS
This study shows that a combined PVI with ASD closure is feasible with an acceptable success rate of AF free survival. These preliminary results in a small patient group warrants a larger trial.
Identifiants
pubmed: 31692272
doi: 10.1111/chd.12859
pmc: PMC7003759
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1123-1129Informations de copyright
© 2019 The Authors. Congenital Heart Disease published by Wiley Periodicals, Inc.
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