Natural outcome of spontaneous closure of iatrogenic atrial septal defect percutaneous left atrial appendage occlusion and its influencing factors_West China Medical Journal

Authors：

WANG Fang , BAI Wenjuan , LIANG Ting , ZHU Wei ,  PENG Ying

Echocardiography Room, Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

PENG Ying, Email: joeypengying2013@163.com

Keywords：

Left atrial appendage occlusion; Iatrogenic atrial septal defect; Echocardiography

DOI：

10.7507/1002-0179.201912054

Video：

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Objective To investigate the natural outcome of spontaneous closure of iatrogenic atrial septal defect (IASD) in patients with atrial fibrillation after transseptal catheterization and the influencing factors affecting its healing.Methods A total of 122 patients who underwent percutaneous left atrial appendage occlusion in West China Hospital, Sichuan University from September 2014 to February 2018 were selected for observation and follow-up. General information of the patients was collected. Each patient underwent transthoracic echocardiography and transesophageal echocardiography before the surgery or 45 days, 3 months, 6 months and 1 year after the surgery, observing the atrioventricular size, cardiac function and atrial septal defect size. The natural outcome of IASD and influencing factors and prognosis of IASD were analyzed.Results The healing rate increased gradually with the follow-up time; the median healing time was 180 days [95% confidence interval (169.5, 190.5) days]. The difference in the effect on IASD healing rate between the gender and atrial fibrillation type was not significant (P>0.05); being older than 70 years old was the influence factor for the IASD healing rate (P<0.05). There was no statistically difference in right heart size and systolic and diastolic function between the unhealed group (n=18) and the healed group (n=63) after a 1-year follow-up (P>0.05), but the left ventricular size was bigger in the unhealed group than that in the healed group (P<0.05). The follow-up time points had a significant effect on the size of the left atrium, and the left atrium in the healing group after 1 year follow-up was significantly smaller than before. There was no significant difference among the different follow-up time points and no interaction between grouping and follow-up time (P>0.05). Conclusions With the extension of follow-up time, the healing rate increases gradually. Larger left atrium and ventricular size and the age over 70 may be related to the healing of IASD.

Citation： WANG Fang, BAI Wenjuan, LIANG Ting, ZHU Wei, PENG Ying. Natural outcome of spontaneous closure of iatrogenic atrial septal defect percutaneous left atrial appendage occlusion and its influencing factors. West China Medical Journal, 2020, 35(7): 821-826. doi: 10.7507/1002-0179.201912054 Copy

1.	Prystowsky EN, Benson DW, Fuster V, et al. Management of patients with atrial fibrillation. A Statement for Healthcare Professionals. From the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation, 1996, 93(6): 1262-1277.
2.	Pappone C, Oral H, Santinelli V, et al. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation, 2004, 109(22): 2724-2726.
3.	佘飞, 刘书旺, 郭丽君. 左心耳封堵术在心房颤动患者中的应用价值. 中国心血管杂志, 2013, 18(6): 409-411.
4.	赵刚, 程蕾蕾, 裴晓黎, 等. 室壁运动异常患者左室射血分数超声心动图检测方法的选择. 中国临床医学, 2016, 23(3): 299-302.
5.	冯婷婷, 贾淑杰, 赵全明. 高密度脂蛋白胆固醇水平与慢性心力衰竭严重程度的相关性. 心肺血管病杂志, 2018, 37(8): 735-739.
6.	Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging, 2016, 29(4): 277-314.
7.	Toyama K, Rader F, Kar S, et al. Iatrogenic atrial septal defect after percutaneous mitral valve repair with the MitraClip system. AmJ Cardiol, 2018, 121(4): 475-479.
8.	Katz NM, Hannan RL, Hopkins RA, et al. Cardiac operations in patients aged 70 years and over: mortality, length of stay, and hospital charge. Ann Thorac Surg, 1995, 60(1): 96-100.
9.	Agrifoglio M, Trabattoni D, Rossi F, et al. Percutaneous closure of iatrogenic atrial septal defect due to implantation of a left-left "Tandem Heart" ventricle assistance device in a postcardiotomy cardiac failure: six-year follow-up. J Cardiovasc Surg (Torino), 2012, 53(2): 270-272.
10.	Losi M, Strisciuglio T, Stabile E, et al. Iatrogenic atrial septal defect (iASD) after MitraClip system delivery: The key role of PaO₂/FiO₂ ratio in guiding post-procedural iASD closure. Int J Cardiol, 2015, 197: 85-86.
11.	Aznaouridis K, Hobson N, Rigg C, et al. Emergency percutaneous closure of an iatrogenic atrial septal defect causing right-to-left shunt and severe refractory hypoxemia after pulmonary vein isolation. JACC Cardiovasc Interv, 2015, 8(11): e179-e181.
12.	Rillig A, Meyerfeldt U, Birkemeyer R, et al. Persistent iatrogenic atrial septal defect after pulmonary vein isolation: incidence and clinical implications. J Interv Card Electrophysiol, 2008, 22(3): 177-181.
13.	Hammerstingl C, Lickfett L, Jeong KM, et al. Persistence of iatrogenic atrial septal defect after pulmonary vein isolation--an underestimated risk?. Am Heart J, 2006, 152(2): 362.e1-362.e5.
14.	Rillig A, Meyerfeldt U, Kunze M, et al. Persistent iatrogenic atrial septal defect after a single-puncture, double-transseptal approach for pulmonary vein isolation using a remote robotic navigation system: results from a prospective study. Europace, 2010, 12(3): 331-336.
15.	Davies A, Gunaruwan P, Collins N, et al. Persistent iatrogenic atrial septal defects after pulmonary vein isolation: long-term follow-up with contrast transesophageal echocardiography. J Interv Card Electrophysiol, 2017, 48(1): 99-103.
16.	吴书林, 廖洪涛, 费洪文, 等. 阵发性心房颤动射频消融术后左房大小和机械功能变化. 中华心血管病杂志, 2007, 35(2): 127-131.
17.	夏曦. 房间隔缺损合并肺动脉高压患儿导管封堵术后左房结构及功能的变化. 临床心血管病杂志, 2015, 31(1): 54-56.
18.	李靖, 刘延玲, 何青, 等. 正常人群年龄进程中心脏结构和功能的变化特点. 中华心血管病杂志, 2010, 38(1): 52-56.
19.	武思雯, 张荣峰, 尹晓盟, 等. 房颤患者术后医源性房间隔缺损发生情况及影响因素分析. 中国医药导报, 2020, 17(11): 44-47.
20.	Singh SM, Douglas PS, Reddy VY. The incidence and long-term clinical outcome of iatrogenic atrial septal defects secondary to transseptal catheterization with a 12F transseptal sheath. Circ Arrhythm Electrophysiol, 2011, 4(2): 166-171.
21.	Noheria A, Roshan J, Kapa S, et al. Migraine headaches following catheter ablation for atrial fibrillation. J Interv Card Electrophysiol, 2011, 30(3): 227-232.

1. Prystowsky EN, Benson DW, Fuster V, et al. Management of patients with atrial fibrillation. A Statement for Healthcare Professionals. From the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation, 1996, 93(6): 1262-1277.
2. Pappone C, Oral H, Santinelli V, et al. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation, 2004, 109(22): 2724-2726.
3. 佘飞, 刘书旺, 郭丽君. 左心耳封堵术在心房颤动患者中的应用价值. 中国心血管杂志, 2013, 18(6): 409-411.
4. 赵刚, 程蕾蕾, 裴晓黎, 等. 室壁运动异常患者左室射血分数超声心动图检测方法的选择. 中国临床医学, 2016, 23(3): 299-302.
5. 冯婷婷, 贾淑杰, 赵全明. 高密度脂蛋白胆固醇水平与慢性心力衰竭严重程度的相关性. 心肺血管病杂志, 2018, 37(8): 735-739.
6. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging, 2016, 29(4): 277-314.
7. Toyama K, Rader F, Kar S, et al. Iatrogenic atrial septal defect after percutaneous mitral valve repair with the MitraClip system. AmJ Cardiol, 2018, 121(4): 475-479.
8. Katz NM, Hannan RL, Hopkins RA, et al. Cardiac operations in patients aged 70 years and over: mortality, length of stay, and hospital charge. Ann Thorac Surg, 1995, 60(1): 96-100.
9. Agrifoglio M, Trabattoni D, Rossi F, et al. Percutaneous closure of iatrogenic atrial septal defect due to implantation of a left-left "Tandem Heart" ventricle assistance device in a postcardiotomy cardiac failure: six-year follow-up. J Cardiovasc Surg (Torino), 2012, 53(2): 270-272.
10. Losi M, Strisciuglio T, Stabile E, et al. Iatrogenic atrial septal defect (iASD) after MitraClip system delivery: The key role of PaO₂/FiO₂ ratio in guiding post-procedural iASD closure. Int J Cardiol, 2015, 197: 85-86.
11. Aznaouridis K, Hobson N, Rigg C, et al. Emergency percutaneous closure of an iatrogenic atrial septal defect causing right-to-left shunt and severe refractory hypoxemia after pulmonary vein isolation. JACC Cardiovasc Interv, 2015, 8(11): e179-e181.
12. Rillig A, Meyerfeldt U, Birkemeyer R, et al. Persistent iatrogenic atrial septal defect after pulmonary vein isolation: incidence and clinical implications. J Interv Card Electrophysiol, 2008, 22(3): 177-181.
13. Hammerstingl C, Lickfett L, Jeong KM, et al. Persistence of iatrogenic atrial septal defect after pulmonary vein isolation--an underestimated risk?. Am Heart J, 2006, 152(2): 362.e1-362.e5.
14. Rillig A, Meyerfeldt U, Kunze M, et al. Persistent iatrogenic atrial septal defect after a single-puncture, double-transseptal approach for pulmonary vein isolation using a remote robotic navigation system: results from a prospective study. Europace, 2010, 12(3): 331-336.
15. Davies A, Gunaruwan P, Collins N, et al. Persistent iatrogenic atrial septal defects after pulmonary vein isolation: long-term follow-up with contrast transesophageal echocardiography. J Interv Card Electrophysiol, 2017, 48(1): 99-103.
16. 吴书林, 廖洪涛, 费洪文, 等. 阵发性心房颤动射频消融术后左房大小和机械功能变化. 中华心血管病杂志, 2007, 35(2): 127-131.
17. 夏曦. 房间隔缺损合并肺动脉高压患儿导管封堵术后左房结构及功能的变化. 临床心血管病杂志, 2015, 31(1): 54-56.
18. 李靖, 刘延玲, 何青, 等. 正常人群年龄进程中心脏结构和功能的变化特点. 中华心血管病杂志, 2010, 38(1): 52-56.
19. 武思雯, 张荣峰, 尹晓盟, 等. 房颤患者术后医源性房间隔缺损发生情况及影响因素分析. 中国医药导报, 2020, 17(11): 44-47.
20. Singh SM, Douglas PS, Reddy VY. The incidence and long-term clinical outcome of iatrogenic atrial septal defects secondary to transseptal catheterization with a 12F transseptal sheath. Circ Arrhythm Electrophysiol, 2011, 4(2): 166-171.
21. Noheria A, Roshan J, Kapa S, et al. Migraine headaches following catheter ablation for atrial fibrillation. J Interv Card Electrophysiol, 2011, 30(3): 227-232.

West China Medical Journal

Natural outcome of spontaneous closure of iatrogenic atrial septal defect percutaneous left atrial appendage occlusion and its influencing factors

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