Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
Heart Rhythm. 2011 Nov;8(11):1669-75. doi: 10.1016/j.hrthm.2011.06.023. Epub 2011 Jun 22.
Percutaneous positioning of closure devices is a well-established treatment of atrial septal defects (ASDs). However, patients who have undergone the procedure are at increased risk for developing atrial fibrillation (AF), and treatment by catheter ablation is underutilized due to the perceived difficulty of obtaining transseptal access in the presence of the closure device.
The purpose of this study was to report the acute and long-term results of radiofrequency catheter ablation of AF in patients with ASD closure devices.
Thirty-nine patients (age 54 ± 6 years, 72% males) with drug-refractory AF (33% paroxysmal, 51% persistent, 16% long-standing persistent) and ASD closure devices (82% Amplatzer, 18% CardioSEAL) underwent radiofrequency catheter ablation. A double transseptal access guided by intracardiac echocardiography was obtained in all patients.
In 35 of 39 patients (90%), the transseptal access was obtained in a portion of the native septum, whereas in 4 of 39 patients (10%), a direct access through the device was required. The latter group had a significantly longer time for achieving the double transseptal access (73.6 ± 1.1 minutes vs. 4.3 ± 0.4 minutes, P < .001), longer fluoroscopy time (122 ± 5 minutes vs. 80 ± 8 minutes, P < .001), and total procedural time (4.1 ± 0.2 hours vs. 3.1 ± 0.3 hours, P < .001). At follow-up of 14 ± 4, months the overall success rate was 77% (85% in paroxysmal AF, 73% in nonparoxysmal AF). Transthoracic contrast-enhanced echocardiography with the Valsalva maneuver, performed between 3 and 6 months after the procedure, failed to detect shunt in all patients.
Radiofrequency catheter ablation of AF is feasible, safe, and effective in patients with ASD closure devices. Transseptal access can be obtained in portions of the native septum in the majority of cases. Direct transseptal puncture of the device is feasible and safe but requires longer time for each transseptal access.
经皮封堵装置定位术是治疗房间隔缺损（ASD）的一种成熟治疗方法。然而，接受该手术的患者发生心房颤动（AF）的风险增加，由于在存在封堵装置的情况下，经导管消融术获得经间隔进入的难度较大，因此该治疗方法的应用不足。
本研究旨在报告经皮封堵装置治疗 ASD 患者 AF 行射频导管消融术的即刻和长期结果。
39 例（年龄 54±6 岁，72%为男性）药物难治性 AF（33%阵发性，51%持续性，16%持久性）患者和 ASD 封堵装置（82%Amplatzer，18%CardioSEAL）接受射频导管消融术。所有患者均通过心内超声引导行双经间隔穿刺。
39 例患者中有 35 例（90%）在部分自身房间隔中获得经间隔进入，而有 4 例（10%）需要通过封堵装置直接进入。后者组获得双经间隔进入的时间明显更长（73.6±1.1 分钟 vs. 4.3±0.4 分钟，P<0.001），透视时间更长（122±5 分钟 vs. 80±8 分钟，P<0.001），总手术时间更长（4.1±0.2 小时 vs. 3.1±0.3 小时，P<0.001）。在 14±4 个月的随访中，整体成功率为 77%（阵发性 AF 为 85%，非阵发性 AF 为 73%）。术后 3 至 6 个月行经胸超声心动图增强对比检查并施行瓦氏动作，所有患者均未发现分流。
在 ASD 封堵装置患者中，行 AF 射频导管消融术是可行、安全且有效的。大多数情况下，可在部分自身房间隔中获得经间隔进入。封堵装置的直接经间隔穿刺是可行且安全的，但每次经间隔进入所需时间更长。
