Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair: A feasibility, safety, and efficacy study

Dhanunjaya Lakkireddy, Umamahesh Rangasetty, Subramanya Prasad, Atul Verma, Mazda Biria, Loren Berenbom, Rhea Pimentel, Martin Emert, Thomas Rosamond, Tamer Fahmy, Dimpi Patel, Luigi Di Biase, Robert Schweikert, David Burkhardt, Andrea Natale

Research output: Contribution to journalArticle

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Abstract

Intracardiac Echo-Guided Radiofrequency Catheter. Introduction: Patients with atrial septal defect (ASD) are at higher risk for atrial fibrillation (AF) even after repair. Transseptal access in these patients is perceived to be difficult. We describe the feasibility, safety, and efficacy of pulmonary vein antral isolation (PVAI) in these patients. Method: We prospectively compared post-ASD/patent foramen ovale (PFO) repair patients (group I, n = 45) with age-gender-AF type matched controls (group II, n = 45). All the patients underwent PVAI through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography (ICE). The short-term (3 months) and long-term (12 month) failure rates were assessed. Results: In group I, 23 (51%) had percutaneous closure devices and 22 (49%) had a surgical closure. There was no significant difference between group I and II in the baseline characteristics. Intracardiac echo-guided double transseptal access was obtained in 98% of patients in group I and in 100% of patients in group II. PVAI was performed in all patients, with right atrial flutter ablation in 7 patients in group I and in 4 patients in group II. Over a mean follow-up of 15 ± 4 months, group I had higher short-term (18% vs 13%, P = 0.77) and long-term recurrence (24% vs 18%, P = 0.6) than group II. There was no significant difference in the perioperative complications between the two groups. Echocardiography at 3 months showed interatrial communication in 2 patients in group I and 1 patient in group II, which resolved at 12 months. Conclusion: Percutaneous AF ablation using double transseptal access is feasible, safe, and efficacious in patients with ASD and PFO repairs.

Original languageEnglish (US)
Pages (from-to)1137-1142
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume19
Issue number11
DOIs
StatePublished - Nov 2008

Fingerprint

Patent Foramen Ovale
Catheter Ablation
Atrial Heart Septal Defects
Atrial Fibrillation
Safety
Pulmonary Veins
Echocardiography
Catheters
Patient Isolation
Atrial Flutter
Patient Rights
Punctures
Research Design
Communication

Keywords

  • ASD devices
  • Atrial fibrillation
  • Intraatrial patches
  • Radiofrequency ablation
  • Transseptal catheterization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair : A feasibility, safety, and efficacy study. / Lakkireddy, Dhanunjaya; Rangasetty, Umamahesh; Prasad, Subramanya; Verma, Atul; Biria, Mazda; Berenbom, Loren; Pimentel, Rhea; Emert, Martin; Rosamond, Thomas; Fahmy, Tamer; Patel, Dimpi; Biase, Luigi Di; Schweikert, Robert; Burkhardt, David; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, Vol. 19, No. 11, 11.2008, p. 1137-1142.

Research output: Contribution to journalArticle

Lakkireddy, D, Rangasetty, U, Prasad, S, Verma, A, Biria, M, Berenbom, L, Pimentel, R, Emert, M, Rosamond, T, Fahmy, T, Patel, D, Biase, LD, Schweikert, R, Burkhardt, D & Natale, A 2008, 'Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair: A feasibility, safety, and efficacy study', Journal of Cardiovascular Electrophysiology, vol. 19, no. 11, pp. 1137-1142. https://doi.org/10.1111/j.1540-8167.2008.01249.x
Lakkireddy, Dhanunjaya ; Rangasetty, Umamahesh ; Prasad, Subramanya ; Verma, Atul ; Biria, Mazda ; Berenbom, Loren ; Pimentel, Rhea ; Emert, Martin ; Rosamond, Thomas ; Fahmy, Tamer ; Patel, Dimpi ; Biase, Luigi Di ; Schweikert, Robert ; Burkhardt, David ; Natale, Andrea. / Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair : A feasibility, safety, and efficacy study. In: Journal of Cardiovascular Electrophysiology. 2008 ; Vol. 19, No. 11. pp. 1137-1142.
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abstract = "Intracardiac Echo-Guided Radiofrequency Catheter. Introduction: Patients with atrial septal defect (ASD) are at higher risk for atrial fibrillation (AF) even after repair. Transseptal access in these patients is perceived to be difficult. We describe the feasibility, safety, and efficacy of pulmonary vein antral isolation (PVAI) in these patients. Method: We prospectively compared post-ASD/patent foramen ovale (PFO) repair patients (group I, n = 45) with age-gender-AF type matched controls (group II, n = 45). All the patients underwent PVAI through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography (ICE). The short-term (3 months) and long-term (12 month) failure rates were assessed. Results: In group I, 23 (51{\%}) had percutaneous closure devices and 22 (49{\%}) had a surgical closure. There was no significant difference between group I and II in the baseline characteristics. Intracardiac echo-guided double transseptal access was obtained in 98{\%} of patients in group I and in 100{\%} of patients in group II. PVAI was performed in all patients, with right atrial flutter ablation in 7 patients in group I and in 4 patients in group II. Over a mean follow-up of 15 ± 4 months, group I had higher short-term (18{\%} vs 13{\%}, P = 0.77) and long-term recurrence (24{\%} vs 18{\%}, P = 0.6) than group II. There was no significant difference in the perioperative complications between the two groups. Echocardiography at 3 months showed interatrial communication in 2 patients in group I and 1 patient in group II, which resolved at 12 months. Conclusion: Percutaneous AF ablation using double transseptal access is feasible, safe, and efficacious in patients with ASD and PFO repairs.",
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T2 - A feasibility, safety, and efficacy study

AU - Lakkireddy, Dhanunjaya

AU - Rangasetty, Umamahesh

AU - Prasad, Subramanya

AU - Verma, Atul

AU - Biria, Mazda

AU - Berenbom, Loren

AU - Pimentel, Rhea

AU - Emert, Martin

AU - Rosamond, Thomas

AU - Fahmy, Tamer

AU - Patel, Dimpi

AU - Biase, Luigi Di

AU - Schweikert, Robert

AU - Burkhardt, David

AU - Natale, Andrea

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N2 - Intracardiac Echo-Guided Radiofrequency Catheter. Introduction: Patients with atrial septal defect (ASD) are at higher risk for atrial fibrillation (AF) even after repair. Transseptal access in these patients is perceived to be difficult. We describe the feasibility, safety, and efficacy of pulmonary vein antral isolation (PVAI) in these patients. Method: We prospectively compared post-ASD/patent foramen ovale (PFO) repair patients (group I, n = 45) with age-gender-AF type matched controls (group II, n = 45). All the patients underwent PVAI through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography (ICE). The short-term (3 months) and long-term (12 month) failure rates were assessed. Results: In group I, 23 (51%) had percutaneous closure devices and 22 (49%) had a surgical closure. There was no significant difference between group I and II in the baseline characteristics. Intracardiac echo-guided double transseptal access was obtained in 98% of patients in group I and in 100% of patients in group II. PVAI was performed in all patients, with right atrial flutter ablation in 7 patients in group I and in 4 patients in group II. Over a mean follow-up of 15 ± 4 months, group I had higher short-term (18% vs 13%, P = 0.77) and long-term recurrence (24% vs 18%, P = 0.6) than group II. There was no significant difference in the perioperative complications between the two groups. Echocardiography at 3 months showed interatrial communication in 2 patients in group I and 1 patient in group II, which resolved at 12 months. Conclusion: Percutaneous AF ablation using double transseptal access is feasible, safe, and efficacious in patients with ASD and PFO repairs.

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KW - ASD devices

KW - Atrial fibrillation

KW - Intraatrial patches

KW - Radiofrequency ablation

KW - Transseptal catheterization

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