Linhart Markus, Werner Jessica T, Stöckigt Florian, Kohlmann Annika T, Lodde Pia C, Linneborn Lutz P T, Beiert Thomas, Hammerstingl Christoph, Borràs Roger, Nickenig Georg, Andrié René P, Schrickel Jan W
Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
J Interv Card Electrophysiol. 2018 Jul;52(2):141-148. doi: 10.1007/s10840-018-0352-0. Epub 2018 Mar 24.
Congenital atrial septal defect (ASD) is associated with increased morbidity, whereas little is known about the rate of spontaneous closure, associated clinical and echocardiographic parameters, or complications of iatrogenic atrial septal defect (iASD) beyond 1 year of follow-up. Persistent iASD after transseptal puncture for PVI has been described in up to 38% of small cohorts of patients in short-term follow-up after transseptal puncture. We sought to investigate the course of iASD after single transseptal puncture for first pulmonary vein isolation (PVI) with cryoballoon, along with possible risk factors for persistent iASD.
After a first PVI with cryoballoon, 102 patients (64 ± 10 years, 64% male) underwent long-term clinical follow-up and comprehensive transthoracic and transesophageal echocardiographic study.
Prevalence of iASD after PVI was 37% after 2.9 (1.6-4.9) years. No clinical complications or deterioration of echocardiographic parameters were associated with iASD. Lower left atrial appendage flow velocity was associated with higher risk of persistence of iASD (3.5% for every 1 cm/s decrease, p = 0.002).
Despite a high rate of iASD after cryoballoon PVI in long-term follow-up, this was not associated with increased clinical complications. Lower LAA velocity was associated with higher risk of persistent iASD. Repeated routine echocardiographic follow-up may not be necessary in these patients.
先天性房间隔缺损（ASD）与发病率增加相关，然而对于自然闭合率、相关临床和超声心动图参数，或医源性房间隔缺损（iASD）随访1年以上的并发症知之甚少。在经房间隔穿刺进行肺静脉隔离（PVI）后的短期随访中，小队列患者中高达38%出现了经房间隔穿刺后持续性iASD。我们旨在研究首次使用冷冻球囊进行肺静脉隔离（PVI）单次经房间隔穿刺后iASD的病程，以及持续性iASD的可能危险因素。
在首次使用冷冻球囊进行PVI后，102例患者（64±10岁，64%为男性）接受了长期临床随访以及全面的经胸和经食管超声心动图研究。
PVI后2.9（1.6 - 4.9）年时，iASD的发生率为37%。iASD与临床并发症或超声心动图参数恶化无关。左心耳血流速度降低与iASD持续存在的风险较高相关（每降低1 cm/s，风险增加3.5%，p = 0.002）。
尽管在长期随访中冷冻球囊PVI后iASD发生率较高，但这与临床并发症增加无关。较低的左心耳速度与持续性iASD的较高风险相关。这些患者可能无需重复进行常规超声心动图随访。
