Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
J Cardiol. 2024 Dec;84(6):372-378. doi: 10.1016/j.jjcc.2024.06.007. Epub 2024 Jun 22.
The left atrium approach for atrial fibrillation (AF) ablation requires an atrial transseptal puncture that may cause an iatrogenic atrial septal defect (iASD). This study aimed to investigate the incidence and predictors of iASD in catheter ablation, assessed by transthoracic echocardiography (TTE), a relatively non-invasive technique frequently employed in follow-up.
This retrospective study included 639 patients (489 male; 60.2±10.7years) who underwent initial catheter ablation for AF between May 2005 and June 2018. All patients underwent preprocedural transesophageal echocardiography (pre-TEE), preprocedural TTE (pre-TTE), and TTE one day after the procedure (post-TTE). iASD incidence after 6months (6M), preprocedural characteristics, and procedure methods were evaluated.
Patent foramen ovale (PFO) was diagnosed in 42 patients (6.6%) using pre-TEE and in 11 patients using pre-TTE (26.2% of the patients with PFO in pre-TEE). Among the 597 patients without PFO, 497 underwent 6M-TTE. iASD was observed in 59.6% of patients using post-TTE and 4.6% using 6M-TTE. In the univariate logistic regression analysis, the total diameter of the sheath through the septum (odds ratio 1.15, p<0.001) or two sheaths through a single puncture (odds ratio 4.17, p=0.001) were independent risk factors on iASD incidence in 6M-TTE. iASD was also more likely to occur via cryoballoon ablation using a larger sheath than radiofrequency catheter ablation.
iASD was not a rare complication. A larger sheath diameter or two sheaths through a single puncture were associated with the incidence of iASD.
房颤（AF）消融的左心房入路需要进行经房间隔穿刺，这可能导致医源性房间隔缺损（iASD）。本研究旨在通过经胸超声心动图（TTE）评估导管消融后 iASD 的发生率和预测因素，TTE 是一种相对非侵入性的技术，常用于随访。
这项回顾性研究纳入了 2005 年 5 月至 2018 年 6 月期间因 AF 首次接受导管消融的 639 例患者（489 例男性；60.2±10.7 岁）。所有患者均在术前接受经食管超声心动图（pre-TEE）、术前 TTE（pre-TTE）和术后一天的 TTE（post-TTE）。评估 6 个月（6M）后 iASD 的发生率、术前特征和手术方法。
42 例患者（6.6%）经 pre-TEE 诊断为卵圆孔未闭（PFO），11 例患者（pre-TEE 中 PFO 患者的 26.2%）经 pre-TTE 诊断为 PFO。在 597 例无 PFO 的患者中，497 例接受了 6M-TTE。post-TTE 发现 iASD 发生率为 59.6%，6M-TTE 发现 iASD 发生率为 4.6%。在单因素逻辑回归分析中，鞘管通过房间隔的总直径（比值比 1.15，p<0.001）或两个鞘管通过单个穿刺点（比值比 4.17，p=0.001）是 6M-TTE 中 iASD 发生率的独立危险因素。与射频导管消融相比，使用较大鞘管的冷冻球囊消融更易发生 iASD。
iASD 并不少见。鞘管直径较大或两个鞘管通过单个穿刺点与 iASD 发生率相关。
