The influence of iatrogenic atrial septal defect on the prognosis of patients with atrial fibrillation between cryoablation and radiofrequency ablation

Abstract

Objective: The present study was to compare the incidence of septal defect (SD) in patients with atrial fibrillation (AF) who received radiofrequency ablation or cryoablation. Methods: A total of 293 AF patients were performed with radiofrequency ablation and cryoablation. Cardiac ultrasonography was performed to calculate left atrial diameter (LAD), left atrial ejection fraction (LAEF%), strain rate (SR), left ventricular systolic (SRs), left ventricular diastolic (SRe), and left atrial systole (SRa) before surgery, 3 months and 1 year after surgery. The patients were followed up to observe statin and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) medication, AF recurrence, 6-min walk test, stroke, any symptoms caused by arrhythmia, and re-hospitalization. Results: The levels of LAD and SD were higher, while SRe and SRa were lower in the cryoablation group in the comparison with the radiofrequency ablation group after surgery (P<0.05). LAEF was lower in the cryoablation group than the radiofrequency ablation group after 3 months (P<0.05). After 1-year follow-up, no right-to-left shunt occurred in all patients with SD. The AF recurrence rate in SD group was higher than that in the normal group (P<0.05). The use of statin and the application of ACEI/ARB were protective factors, whereas hypertension, LAD, left atrial operation time, and surgical plan were risk factors. Conclusion: SD affects left atrial function and increases the risk of AF recurrence. Hypertension, LAD, and left atrial operation time are risk factors for SD, whereas statin and ACEI/ARB drugs can reduce SD.

A Novel Puncturable Atrial Septal Defect Occluder

“…In addition, mitral regurgitation may be associated with ASD closure in such patients. 2 , 3 , 14 , 15 Currently, these diseases are increasingly treated by transcatheter interventions, which all require atrial septal puncture. 4 , 5 , 6 At present, the structures of all conventional ASD occluders with marketing availability are 2 disc and 1 waist self-expanding structures.…”

“…Most patients undergoing ASD closure are relatively young, and the long-term rate of complication with atrial fibrillation (AF) and mitral regurgitation is as high as 20%. 2 , 3 These complications are generally treated with transcatheter intervention, such as radiofrequency ablation, left atrial appendage occlusion, and transcatheter edge-to-edge mitral valve repair. 4 , 5 , 6 These techniques of transcatheter intervention all require transfemoral catheterization through the atrial septum to access the left atrium for the treatment procedures.…”

Persistent iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation

“…Moreover, the incidence of iASD following PVI was founded to be significantly higher in the CBA group, which larger Ts (15F) catheter was used, compared to RF ablation group. 8,14, 15 In MitraClip system the 22Fr transseptal catheter is used to reach mitral valve and iASD was found up to 50% of sixty-six patients at 6 months by TEE. 16 As a result of above-mentioned articles, smaller Ts punctures although multiple have higher tendency to close.…”

Angiotensin‐receptor blocker losartan alleviates atrial fibrillation in rats by downregulating frizzled 8 and inhibiting the activation of WNT‐5A pathway

“…14 Septal defect affects left atrial function and increases the risk of AF recurrence, whereas angiotensin-converting enzyme inhibitor/ ARB can reduce septal defect. 15 Losartan can prevent left ventricular systolic dysfunction in rats with myocardial infarction. 16 ARB can prevent atrial structural remodelling induced by long-term inhibition of nitric oxide synthesis in hypertensive rats, and atrial structural remodelling may be one of the triggers of AF.…”

“…AF is related to atria progressive structural and electrical remodelling, and ARB and related mediators are centrally involved in atrial fibrosis 14 . Septal defect affects left atrial function and increases the risk of AF recurrence, whereas angiotensin‐converting enzyme inhibitor/ARB can reduce septal defect 15 . Losartan can prevent left ventricular systolic dysfunction in rats with myocardial infarction 16 .…”