Percutaneous Radiofrequency Catheter Ablation for Atrial Fibrillation Prior to Atrial Septal Defect Closure

Atrial septal defects (ASDs) are among the most common of congenital heart defects and are frequently associated with atrial arrhythmias. Atrial and ventricular geometrical remodelling secondary to the intracardiac shunt promotes evolution of the electrical substrate, predisposing the patient to atrial fibrillation and other arrhythmias. Closure of an ASD reduces the immediate and long-term prevalence of atrial arrhythmias, but the evidence suggests that patients remain at an increased long-term risk in comparison with the normal population. The closure technique itself and its timing impacts future arrhythmia risk profile while subsequent transseptal access following surgical or device closure is complicated. Newer techniques combined with increased experience will help to alleviate some of the difficulties associated with optimal management of arrhythmias in these patients.

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“…There are also very limited reports of RF catheter ablation prior to device closure of ASD at a separate procedure. 45…”

Section: Pre-emptive Treatmentmentioning

confidence: 99%

Pathophysiology and Management of Arrhythmias Associated with Atrial Septal Defect and Patent Foramen Ovale

Chubb

Whitaker

Williams

et al. 2014

Arrhythm Electrophysiol Rev

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“…Endovascular pulmonary vein isolation (PVI) has been described in a limited number of patients. Four patients with an ASD and either paroxysmal ( N = 2) or persistent ( N = 2) AF were scheduled for percutaneous closure of the ASD [ 31 ]. Prior to closure, endovascular PVI was performed in all 4 patients; additional lesions were created in the 2 patients with persistent AF including a circular lesion around the superior caval vein and a linear lesion connecting the right and left pulmonary veins and mitral isthmus line.…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Tachyarrhythmia in patients with congenital heart disease: inevitable destiny?

Teuwen

Taverne²,

Houck

et al. 2016

Neth Heart J

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“…In our population no other than concomitant surgical procedures were performed although several other types of invasive therapy have been described in literature and proven to be safe and effective. [27][28][29] Our own group showed that a pulmonary vein isolation together with ASD closure in the same procedure can be performed safely with a good effect on recurrence rate in symptomatic patients with AF and an ASD. 30 Future studies are needed on the best treatment option of AF in patients with an ASD.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation in patients with an atrial septal defect in a single centre cohort during a long clinical follow-up: its association with closure and outcome of therapy

et al. 2020

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ObjectiveCurrently, consensus is lacking on the relation between closure of atrial septal defect (ASD) and the incidence of atrial fibrillation (AF), which is a known complication in ASD patients. More importantly, studies reporting on the treatment applied for AF in ASD patients are scarce. The aims of this study were (1) to assess the incidence of AF in ASD patients, (2) to study the relation between closure and AF and (3) to evaluate applied treatment strategies.MethodsA single-centre retrospective study in 173 patients with an ASD was performed. We analysed the incidence of AF, the relation of AF with closure, method of closure and the treatment success of therapies applied.ResultsAlmost 20% of patients with an ASD developed AF, with a mean age of 59 (±14) years at first presentation of AF during a median clinical follow-up of 43 (29–59) years. Older age (OR 1.072; p<0.001) and a dilated left atrium (OR 3.727; p=0.009) were independently associated with new-onset AF. Closure itself was not independently associated with AF. First applied treatment strategy was rhythm control in 77%. Of the 18 patients treated with antiarrhythmic drugs 50% had at least 1 recurrence of AF.ConclusionNo clear relation between closure of the ASD and AF could be assessed. This is the first study describing applied therapy for AF in ASD patients of which medical rhythm control was the most applied strategy with a disappointing efficacy.

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Percutaneous Radiofrequency Catheter Ablation for Atrial Fibrillation Prior to Atrial Septal Defect Closure

Cited by 16 publications

References 11 publications

Pathophysiology and Management of Arrhythmias Associated with Atrial Septal Defect and Patent Foramen Ovale

Pathophysiology and Management of Arrhythmias Associated with Atrial Septal Defect and Patent Foramen Ovale

Tachyarrhythmia in patients with congenital heart disease: inevitable destiny?

Atrial fibrillation in patients with an atrial septal defect in a single centre cohort during a long clinical follow-up: its association with closure and outcome of therapy

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