Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
EuroIntervention. 2022 Jan 28;17(13):1112-1119. doi: 10.4244/EIJ-D-21-00340.
An atrial septal occluder (ASO) represents a major obstacle to the widespread adoption of atrial fibrillation (AF) catheter ablation in patients with prior atrial septal defect (ASD) closure.
The aim of this study was to describe the 'sequential technique' of transseptal puncture (TSP) in AF patients with ASO.
Sixty-four drug-refractory AF patients with ASO who underwent catheter ablation in our centre from September 2007 to March 2020 were enrolled.
Puncture through the native septum was achieved in 29 patients (Group A) and through the device in 35 patients (Group B). The mean diameter of the occluder was significantly larger in Group B than in Group A (31.6±4.6 mm vs 22.8±3.5 mm, p<0.001). The mean time of TSP (24.9±8.8 vs 5.8±2.1 min, p<0.001), total fluoroscopy time (23.7±10.9 vs 7.5±4.4 min, p<0.001), and total procedure time (172.7±58.3 vs 123.4±43.8 min, p=0.001) of Group B were significantly longer than those of Group A. In Group B, the external sheath crossed the device by reshaping the needle and adjusting the puncture angle and position in 23 patients (Group B1), while the external sheath crossed the device with the assistance of balloon dilation in 12 patients (Group B2). No patient had thrombus, periprocedural interatrial shunt or procedural complications.
TSP and AF ablation in patients with ASO are feasible and safe. The 'sequential technique' could be safely used in patients with ASO.
在既往房间隔缺损（ASD）封堵的患者中，使用心房颤动（AF）导管消融治疗存在房间隔封堵器（ASO）的问题。
本研究旨在描述 AF 合并 ASO 患者中经间隔穿刺（TSP）的“序贯技术”。
2007 年 9 月至 2020 年 3 月，我院共纳入 64 例药物难治性 AF 合并 ASO 患者行导管消融术。
29 例患者（A 组）穿刺穿过自身房间隔，35 例患者（B 组）穿刺穿过封堵器。B 组封堵器的平均直径明显大于 A 组（31.6±4.6mm 比 22.8±3.5mm，p<0.001）。B 组 TSP 时间（24.9±8.8min 比 5.8±2.1min，p<0.001）、透视总时间（23.7±10.9min 比 7.5±4.4min，p<0.001）和总手术时间（172.7±58.3min 比 123.4±43.8min，p=0.001）明显长于 A 组。在 B 组中，23 例患者通过重塑穿刺针和调整穿刺角度及位置使外鞘穿过封堵器（B1 组），12 例患者在球囊扩张辅助下使外鞘穿过封堵器（B2 组）。所有患者均无血栓形成、围术期房间隔分流或操作相关并发症。
在合并 ASO 的患者中进行 TSP 和 AF 消融是可行且安全的。“序贯技术”可安全应用于合并 ASO 的患者。
