Transseptal puncture and catheter ablation of atrial fibrillation in patients with atrial septal occluder: initial experience of a single centre
Transseptal puncture and catheter ablation of atrial fibrillation in patients with atrial septal occluder: initial experience of a single centre
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房间隔封堵器患者心房颤动的房间隔穿刺和导管消融：单中心的初步经验。
DOI：
10.1093/europace/eux282
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发表时间：
2018-09-01
期刊：
影响因子：
6.1
通讯作者：
Ma, Chang-Sheng
中科院分区：
文献类型：
--
作者：
Sang, Cai-Hua;Dong, Jian-Zeng;Ma, Chang-Sheng
目的房间隔缺损（ASD）患者行房间隔封堵器（ASO）植入术后，导管消融未得到充分应用。本研究评估导管消融治疗心房颤动（AF）在这类患者中的可行性和安全性。方法和结果16例（年龄56±12岁，男性10例）既往植入ASO的难治性房颤患者（阵发性10例，持续性6例）。如果不能实现固有的中隔通道，则使用球囊扩张封闭装置。对于阵发性房颤，消融策略是环肺静脉隔离（CPVI），对于持续性房颤，进行额外的线性消融。11例患者（A组）通过天然鼻中隔进入，5例患者使用球囊扩张通过ASO进入（B组）。所有16例患者均实现了环肺静脉隔离，除1例患者未实现二尖瓣峡部阻断外，所有持续性患者均实现了线性阻断。A组与B组的间隔透视时间、全透视时间和手术时间分别为5 +/- 3分钟vs. 38 +/- 8分钟、31 +/- 11分钟vs. 54 +/- 15分钟、165 +/- 35分钟vs. 224 +/- 36分钟（均P < 0.05）。随访3个月，经胸超声心动图未发现心房分流。在16 +/- 6个月的随访中，16例患者中有12例维持窦性心律。无严重并发症。结论ASD合并ASO患者房颤导管消融是可行、安全、有效的。球囊扩张技术可以方便地通过ASO经隔膜进入。
Aims Catheter ablation is underutilized in atrial septal defect (ASD) patients who have undergone implantation of an atrial septal occluder (ASO). This study evaluates the feasibility and safety of catheter ablation of atrial fibrillation (AF) in this subset of patients.Methods and results Sixteen patients (age 56 +/- 12 years, 10 men) with drug-refractory AF (10 paroxysmal and 6 persistent) and previously implanted ASO were enrolled. Balloon dilatation of the closure device was performed if the native septum passage could not be achieved. For paroxysmal AF, the ablation strategy was circumferential pulmonary vein isolation (CPVI), and for persistent AF, additional linear ablation was performed. Transseptal access was achieved through the native septum in 11 patients (Group A) and through the ASO using balloon dilatation in 5 patients (Group B). Circumferential pulmonary vein isolation was achieved in all 16 patients, and linear block was achieved in all persistent patients except for 1 patient who did not achieve mitral isthmus block. The transseptal, total fluoroscopy, and procedural durations were 5 +/- 3 vs. 38 +/- 8 min, 31 +/- 11 vs. 54 +/- 15 min, and 165 +/- 35 vs. 224 +/- 36 min, respectively, in Group A vs. Group B, respectively (all P < 0.05). No shunt at atrial level was detected by transthoracic echocardiography at 3-month follow-up. During a follow-up of 16 +/- 6 months, sinus rhythm was maintained in 12 of 16 patients. No severe complications were observed.Conclusion In ASD patients with ASO, catheter ablation of AF is feasible, safe, and effective. The balloon dilatation technique can facilitate transseptal access through the ASO.