Evertz Reinder, Houck Charlotte A, Ten Cate Tim, Duijnhouwer Anthonie L, Beukema Rypko, Westra Sjoerd, Vernooy Kevin, de Groot Natasja M S
Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Congenit Heart Dis. 2019 Nov;14(6):1123-1129. doi: 10.1111/chd.12859. Epub 2019 Nov 6.
Patients with an atrial septal defect (ASD) are at increased risk of developing atrial fibrillation (AF). Currently percutaneous ASD closure is the preferred therapeutic strategy and although pulmonary vein isolation (PVI) for AF is feasible after ASD closure, the transseptal puncture can be technically challenging and probably increases the perioperative risk. A staged approach, with PVI several months before ASD closure, has been recommended for patients already scheduled for closure, but no data are available on combined procedures.
This pilot study evaluates the feasibility of a combined procedure of PVI and ASD closure in patients with a hemodynamic important ASD and documented AF.
In one procedure, PVI was performed prior to placement of the ASD closure device. Transseptal access for PVI was obtained via wire passage through the ASD in all patients. Patients were followed with 5-day-holter monitoring at 3, 6, and 12 months. Recurrence of AF was defined as a documented, symptomatic episode of AF.
The study population consisted of five patients (four females, mean age: 58 (±3) years). Acute PVI was achieved in all patients. Only one patient had a small residual ASD after closure. Besides a small groin hematoma in two patients, no complications occurred. After 12-month follow-up, three patients were free of AF recurrence (60%).
This study shows that a combined PVI with ASD closure is feasible with an acceptable success rate of AF free survival. These preliminary results in a small patient group warrants a larger trial.
房间隔缺损（ASD）患者发生心房颤动（AF）的风险增加。目前，经皮ASD封堵术是首选的治疗策略，虽然ASD封堵术后行肺静脉隔离（PVI）治疗AF是可行的，但经房间隔穿刺在技术上具有挑战性，且可能增加围手术期风险。对于已计划进行封堵的患者，建议采用分阶段方法，即在ASD封堵术前数月进行PVI，但尚无关于联合手术的数据。
本前瞻性研究评估在具有血流动力学意义的ASD且记录有AF的患者中，PVI与ASD封堵联合手术的可行性。
在一次手术中，于放置ASD封堵装置之前进行PVI。所有患者均通过经ASD导丝通路获得PVI的经房间隔入路。在3、6和12个月时对患者进行为期5天的动态心电图监测。AF复发定义为记录到的有症状的AF发作。
研究人群包括5例患者（4例女性，平均年龄：58（±3）岁）。所有患者均成功完成急性PVI。仅1例患者封堵后有小的残余ASD。除2例患者出现小的腹股沟血肿外，未发生其他并发症。随访12个月后，3例患者无AF复发（60%）。
本研究表明，PVI与ASD封堵联合手术是可行的，AF无复发生存成功率可接受。这一小患者群体的初步结果值得进行更大规模的试验。
