Percutaneous Catheter Ablation of Atrial Fibrillation in Patients with Post-Atrial Septal Defect Device Closure & Operation

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Background: Transseptal puncture (TSP) and left atrial (LA) ablation is perceived to be difficult in patients with closure of atrial septal defect (ASD). We described our experience with catheter ablation of AF via TSP in patients with repaired ASD. Methods: Among 8 patients with repaired ASD, 6 patients underwent surgical repair (patch 5: pericardium 2, Dacron 2, Gore-Tex 1; suture closure 1) and Amplatzer occluder was used in 2 patients. Results: Double TSP followed by LA catheter ablation was performed in all patients 14±11 years after ASD closure. Atrial tachycardia (AT) was documented/induced in 7 patients, in whom carvo-tricuspid isthmus was ablated. AT was terminated in 4 patients during ablation nearby closure device/material (1 right PV; 1 posterior wall of right atrium; 2 right septum). In 7 patients, there was no inducible AF/AT after ablation. There was no complication. During mean 18-month, there was no recurrence of AF/AT after procedure. No evidence of iatrogenic shunt flow was shown at the TSP site in 3 patients with echocardiographic follow-up after median 6 months. Conclusion: Percutaneous catheter ablation via TSP is feasible and safe in patients with repaired ASD and has a good long-term outcome. The ASD closure device/matrial can be a part of the substrate of coexisted AT.