Davies Allan, Gunaruwan Prasad, Collins Nicholas, Barlow Malcolm, Jackson Nick, Leitch James
Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, 2305, NSW, Australia.
Gold Coast University Hospital, Southport, QLD, Australia.
J Interv Card Electrophysiol. 2017 Jan;48(1):99-103. doi: 10.1007/s10840-016-0193-7. Epub 2016 Sep 28.
Pulmonary vein isolation using cryoballoon ablation is an established approach to treating atrial fibrillation. The procedure involves insertion of a 15-Fr sheath into the left atrium across the interatrial septum. This creates an iatrogenic atrial septal defect, which may have important long-term clinical relevance, especially in younger patients. We sought to determine the long-term incidence of these defects and determine the direction of shunt using contrast transesophageal echocardiography.
Individuals who had undergone a single pulmonary vein isolation procedure were invited to attend for transesophageal echocardiography (TOE). Patients who had undergone more than one procedure involving puncture of the interatrial septum were excluded. The interatrial septum was interrogated using two-dimensional imaging, color flow Doppler, and microbubble contrast study.
A total of 27 patients were recruited with a median follow-up time of 553 days from pulmonary vein isolation to TOE. Seven patients had persistent iatrogenic atrial septal defects with three demonstrating right to left shunt either at rest or with Valsalva. There were no reported adverse events during the study period.
Persistent iatrogenic atrial septal defects are relatively common following cryoballoon ablation procedures. Right to left shunting can be observed using microbubble contrast in a subset of patients with iatrogenic atrial septal defect (iASD). Further studies that longitudinally assess shunt fraction, pulmonary artery pressure, and the incidence of paradoxical embolism are needed to better understand the clinical impacts of such defects.
使用冷冻球囊消融术进行肺静脉隔离是治疗心房颤动的一种既定方法。该手术包括经房间隔将一个15F鞘管插入左心房。这会造成医源性房间隔缺损，其可能具有重要的长期临床意义，尤其是在年轻患者中。我们试图确定这些缺损的长期发生率，并使用对比经食管超声心动图确定分流方向。
邀请接受过单次肺静脉隔离手术的个体前来进行经食管超声心动图（TOE）检查。排除接受过不止一次涉及房间隔穿刺手术的患者。使用二维成像、彩色多普勒血流显像和微泡对比研究对房间隔进行检查。
共招募了27名患者，从肺静脉隔离到TOE的中位随访时间为553天。7名患者存在持续性医源性房间隔缺损，其中3名在静息或瓦尔萨尔瓦动作时显示右向左分流。研究期间未报告不良事件。
冷冻球囊消融术后持续性医源性房间隔缺损相对常见。在一部分医源性房间隔缺损（iASD）患者中，使用微泡对比可观察到右向左分流。需要进一步纵向评估分流分数、肺动脉压力和矛盾栓塞发生率的研究，以更好地了解此类缺损的临床影响。
