Abstract 12499: The Incidence and Predictor of Persistent Iatrogenic Atrial Septal Defect in Patients Who Underwent Catheter Ablation

Abstract

Background: The left atrium approach for atrial fibrillation (AF) ablation requires an atrial transseptal puncture that may cause an iatrogenic atrial septal defect (iASD). Aims: This study aims to investigate the incidence and predictor of iASD in patients who underwent catheter ablation. Methods: This retrospective study included 639 patients (489 male; 60.2 ± 10.7 years) who underwent initial catheter ablation for AF between May 2005 and June 2018. All patients received preoperative transesophageal echocardiography (pre-TEE), preoperative transthoracic echocardiography (pre-TTE), and TTE one day after the procedure (post-TTE). TTE 6 months after the procedure (6M-TTE) was performed in 533 patients. The iASD incidence after 6 months, pre-procedure characteristics, and methods were evaluated. Results: Patent foramen ovale (PFO) was diagnosed in 6.6% (42/639) using pre-TEE and detected in 26.2% (11/42) using pre-TTE. Of the 533 patients who underwent 6M-TTE, 497 had no PFO using pre-TEE. iASD was observed in 59.6% (296/497) using post-TTE and 4.6% (23/497) using 6M-TTE. In the multivariate analysis, the total diameter of sheath through the septum (OR 1.21, p < 0.001) or two sheaths placed through a single puncture (OR 4.26, p = 0.001) was the independent risk factor on iASD incidence in 6M-TTE. iASD was more likely to occur in cryoballoon ablation using a larger sheath than radiofrequency catheter ablation. Conclusions: iASD was not a rare complication. A larger sheath diameter or two sheaths placed through a single puncture might be associated with the incidence of iASD. Careful procedural considerations might be required for patients with hemodynamic deterioration by iASD.