A Very Long-term Longitudinal Study on the Evolution and Clinical Outcomes of Persistent Iatrogenic Atrial Septal Defect After Cryoballoon Ablation

Iatrogenic atrial septal defect caused by repeated catheter ablation

“…2 Persistent iASD is reported to have a prevalence ranging from 3.2% to 50%, depending on the procedures and devices. 3,4 The risk of persistent iASD seems to increase in accordance with the sheath diameter. 1 Persistent iASD is the issue to consider with the progress in advanced percutaneous interventions for structural heart diseases.…”

Iatrogenic Atrial Septal Defects After Transseptal Access for Atrial Fibrillation Ablations

“…Estimates range from 8.4% of patients at a median follow-up of 15.5 months using transthoracic echocardiography 7 to 37% at 2.9 years using a combination of transthoracic and transthoracic echocardiography follow-up. 8 In comparison with much of the prior published data, the study by Chan et al 6 has a reasonable number of patients with concise TEE and clinical follow-up and a low dropout rate. 6 Therefore, it seems reasonable to conclude that approximately one fifth of patients who undergo cryoablation for AF will develop a longterm iASD after the procedure.…”

“…8 In comparison with much of the prior published data, the study by Chan et al 6 has a reasonable number of patients with concise TEE and clinical follow-up and a low dropout rate. 6 Therefore, it seems reasonable to conclude that approximately one fifth of patients who undergo cryoablation for AF will develop a longterm iASD after the procedure.…”

“…4 The use of a single large sheath for cryoablation appears to have a significantly higher risk of longterm iASD compared with using smaller-diameter radiofrequency catheters. 5 In this issue of the Canadian Journal of Cardiology, Chan et al 6 describe the prevalence of iASDs after TS access for 108 AF ablations using a 15F steerable sheath for pulmonary vein isolation using a cryoballoon. No patients in the study had prior TS access, and a baseline transesophageal echocardiogram (TEE) performed 1 day before the procedure showed no pre-existent ASD, interatrial septal aneurysm, or echocardiographically evident patent foramen ovale.…”

“…Other than the number of cryoablation applications performed, there were no other factors that increased the risk of iASD. 6 Although more cryoablation applications did not translate into longer procedural times, more manipulation of the sheath may have been required, which could explain this potential interaction.…”