Department of Cardiology, Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Academic Hospital of the University of Freiburg Vöhrenbacherstr, 23, Villingen-Schwenningen, Germany.
Europace. 2010 Mar;12(3):331-6. doi: 10.1093/europace/eup428. Epub 2010 Jan 15.
Persistent iatrogenic atrial septal defect (iASD) after transseptal puncture for pulmonary vein isolation (PVI) has been described recently as a complication of PVI. No data exists evaluating systematically the incidence and clinical implications of iASDs after PVI using a remote robotic navigation system (RNS) with sheaths with a distinct larger outer diameter.
In this prospective study, 40 patients with either paroxysmal (n = 22, 55%) or persistent symptomatic atrial fibrillation were treated with circumferential PVI using an RNS. In all patients, a single-puncture, double-transseptal approach was used to access the left atrium. Transoesophageal echocardiography was performed before and the day after PVI as well as after a 3 and 6 months follow-up (FU). The day after ablation an iASD was detected in 38 of 40 (95%) patients with a mean diameter of 3.45 +/- 1.5 mm. At 6-month FU, the iASDs were closed in 30 of 39 (78.9%) patients. During the 6-month FU period, no patient died or suffered from cerebral or cardiac embolism.
After a single-puncture, double-transseptal approach for PVI using the RNS, iASDs show a high spontaneous closure rate of 78.9% after a 6-month FU period. Persistent iASDs following PVI with the RNS are not associated with an increased rate of paradoxical embolism or with relevant shunting.
经房间隔穿刺行肺静脉隔离（PVI）后持续性医源性房间隔缺损（iASD）最近被描述为 PVI 的一种并发症。目前尚无数据评估使用具有明显较大外径鞘管的远程机器人导航系统（RNS）行 PVI 后 iASD 的发生率及其临床意义。
在这项前瞻性研究中，40 例阵发性（n=22，55%）或持续性有症状心房颤动患者接受了使用 RNS 的环肺静脉隔离治疗。所有患者均采用单次穿刺、双房间隔入路进入左心房。在 PVI 前、后及 3 个月和 6 个月随访（FU）时进行经食管超声心动图检查。PVI 后 1 天，40 例患者中有 38 例（95%）发现 iASD，平均直径为 3.45±1.5mm。在 6 个月 FU 时，39 例患者中有 30 例（78.9%）iASD 闭合。在 6 个月 FU 期间，无患者死亡或发生脑或心源性栓塞。
使用 RNS 行单次穿刺、双房间隔入路 PVI 后，iASD 在 6 个月 FU 期间有较高的自发闭合率（78.9%）。RNS 行 PVI 后持续性 iASD 与反常栓塞发生率增加或相关分流无关。
