Cath lab: Outcome of ASD created by Transseptal puncture

The Incidence and Long-Term Clinical Outcome of Iatrogenic Atrial Septal Defects Secondary to Transseptal Catheterization with a 12Fr Transseptal Sheath

1. Sheldon M. Singh1*,
2. Pamela S. Douglas2 and
3. Vivek Y. Reddy1

1. ¹ Mount Sinai School of Medicine, New York, NY;
2. ² Duke Clinical Research Institute, Durham,

Abstract

Background—Studies assessing the presence of a residual iatrogenic atrial septal defect (iASD) after transseptal catheterization with 8Fr transseptal sheaths have suggested that the majority of these iASD close within 6 months. However, these studies have been limited by small patient numbers and short follow-up. Additionally, there are a number of novel catheter procedures in interventional cardiology and electrophysiology that employ larger transseptal sheaths. The objective of this study was to assess the incidence of and complications associated with iASD in a large cohort of patients undergoing transseptal catheterization with a 12Fr transseptal sheath.

Methods and Results—253 patients without a pre-existing inter-atrial shunt undergoing WATCHMAN implantation as part of the PROTECT AF study were included in this current study. Patients underwent transesophageal echocardiography (TEE) with echo-contrast immediately post-procedure, 45-days, 6 months, and 12 months. 87% of patients had an iASD immediately post-procedure, the majority of which sealed by 6 months (incidence of iASD - 34% at 45 days, 11% at 6 months, 7% at 12 months). While the majority of iASDs were >3mm in diameter immediately post-procedure, the minority of iASD were >3mm during the follow-up period. Additionally, inter-atrial shunting was predominantly left-to-right when an iASD was present. There was no significant difference in the rate of stroke and/or systemic embolism during the follow up period in patients with or without iASD.

Conclusions—Transseptal catheterization procedures with a large diameter transseptal sheath have a high spontaneous closure rate of iASD, and is not associated with an increased rate of stroke / systemic embolization during long-term follow-up.

• Received July 29, 2010.
• Accepted December 20, 2010.