Iatrogenic Atrial Septal Defects After Transseptal Puncture for Percutaneous Left Atrial Appendage Occlusion and Their Hemodynamic Effects

Overview

Journal J Geriatr Cardiol

Specialty Geriatrics

Date 2022 Oct 26

PMID 36284683

Authors

Ioannis Drosos

Roberta de Rosa

Philipp C Seppelt

Sebastian Cremer

Silvia Mas-Peiro

Katrin Hemmann

Jana Oppermann

Recha Blessing

Mariuca Vasa-Nicotera

Andreas M Zeiher

Zisis Dimitriadis

Affiliations

Soon will be listed here.

Abstract

Background: Percutaneous left atrial appendage occlusion (LAAO) requires puncture of the interatrial septum. The immediate hemodynamic effects of iatrogenic atrial septal defects (iASD) after LAAO have not been examined so far. We aimed at evaluating these effects through invasive measurements of pressure and oxygen saturation. Moreover, we assessed the incidence of persistent iASD at three months.

Methods: Forty-eight patients scheduled for percutaneous LAAO were prospectively included in the study. Pressure and oxygen saturation were measured (1) in the right atrium (RA) before transseptal puncture, (2) in the left atrium (LA) through the transseptal sheath after transseptal puncture, (3) in the LA after removal of introducer sheath, and (4) in the RA after removal of introducer sheath. Transesophageal echocardiography was performed at three months to detect iASD.

Results: Pressure in the RA increased significantly after removing the introducer sheath ( = 0.034), whereas no difference was found in oxygen saturation in the RA ( = 0.623). Pressure measurement in the LA showed no significant difference after removing the introducer sheath ( = 0.718). Oxygen saturation in the LA also showed no significant difference ( = 0.129). Follow-up transesophageal echocardiogram at 3 months revealed a persistent iASD in 4 patients (8.5 %).

Conclusions: Our study suggests that iASD after percutaneous LAAO does not result in significant shunts directly after the procedure, although a significant increase of mean right atrial pressure can be observed. Persistent iASDs after percutaneous LAAO seem to be relatively rare at three months.

References

Schueler R, Ozturk C, Wedekind J, Werner N, Stockigt F, Mellert F . Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system: a note of caution. JACC Cardiovasc Interv. 2015; 8(3):450-459. DOI: 10.1016/j.jcin.2014.10.024. View

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax J, Blomstrom-Lundqvist C . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the.... Eur Heart J. 2020; 42(5):373-498. DOI: 10.1093/eurheartj/ehaa612. View

Paukovitsch M, Schneider L, Reichart C, Nita N, Rottbauer W, Kessler M . Prevalence of iatrogenic atrial septal defects (iASD) after mitral valve (MV) transcatheter edge-to-edge repair (TEER) in the long-term follow-up. Open Heart. 2021; 8(2). PMC: 8549666. DOI: 10.1136/openhrt-2021-001732. View

Osmancik P, Herman D, Neuzil P, Hala P, Taborsky M, Kala P . Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation. J Am Coll Cardiol. 2020; 75(25):3122-3135. DOI: 10.1016/j.jacc.2020.04.067. View

Eden M, Leeb L, Frey N, Rosenberg M . Haemodynamics of an iatrogenic atrial septal defect after MitraClip implantation. Eur J Clin Invest. 2020; 50(10):e13295. DOI: 10.1111/eci.13295. View

Ikenaga H, Hayashi A, Nagaura T, Yamaguchi S, Yoshida J, Rader F . Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip. Heart. 2018; 105(11):864-872. DOI: 10.1136/heartjnl-2018-313839. View

Nielsen-Kudsk J, Korsholm K, Damgaard D, Valentin J, Diener H, Camm A . Clinical Outcomes Associated With Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulation in Atrial Fibrillation. JACC Cardiovasc Interv. 2021; 14(1):69-78. DOI: 10.1016/j.jcin.2020.09.051. View

Glikson M, Wolff R, Hindricks G, Mandrola J, Camm A, Lip G . EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion - an update. EuroIntervention. 2019; 15(13):1133-1180. DOI: 10.4244/EIJY19M08_01. View

Nelles D, Vij V, Al-Kassou B, Weber M, Vogelhuber J, Beiert T . Incidence, persistence, and clinical relevance of iatrogenic atrial septal defects after percutaneous left atrial appendage occlusion. Echocardiography. 2021; 39(1):65-73. DOI: 10.1111/echo.15271. View

10.

Reddy V, Doshi S, Kar S, Gibson D, Price M, Huber K . 5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials. J Am Coll Cardiol. 2017; 70(24):2964-2975. DOI: 10.1016/j.jacc.2017.10.021. View

11.

Benjamin E, Muntner P, Alonso A, Bittencourt M, Callaway C, Carson A . Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019; 139(10):e56-e528. DOI: 10.1161/CIR.0000000000000659. View

12.

Holmes D, Reddy V, Turi Z, Doshi S, Sievert H, Buchbinder M . Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. 2009; 374(9689):534-42. DOI: 10.1016/S0140-6736(09)61343-X. View

13.

Alachkar M, Alnaimi A, Reith S, Altiok E, Schroder J, Marx N . Incidence and clinical relevance of persistent iatrogenic atrial septal defect after percutaneous mitral valve repair. Sci Rep. 2021; 11(1):12700. PMC: 8209228. DOI: 10.1038/s41598-021-92255-3. View

14.

Puga L, Teixeira R, Paiva L, Ribeiro J, Gameiro J, Sousa J . Iatrogenic atrial septal defect after percutaneous left atrial appendage closure: a single-center study. Int J Cardiovasc Imaging. 2021; 37(8):2359-2368. DOI: 10.1007/s10554-021-02212-4. View

15.

Gloekler S, Furholz M, De Marchi S, Kleinecke C, Streit S, Buffle E . Left atrial appendage closure versus medical therapy in patients with atrial fibrillation: the APPLY study. EuroIntervention. 2020; 16(9):e767-774. DOI: 10.4244/EIJ-D-20-00201. View

16.

Smith T, McGinty P, Bommer W, Low R, Lim S, Fail P . Prevalence and echocardiographic features of iatrogenic atrial septal defect after catheter-based mitral valve repair with the MitraClip system. Catheter Cardiovasc Interv. 2012; 80(4):678-85. DOI: 10.1002/ccd.23485. View

17.

Lurz P, Unterhuber M, Rommel K, Kresoja K, Kister T, Besler C . Iatrogenic Atrial Septal Defects Following Transcatheter Mitral Valve Repair and Implications of Interventional Closure. JACC Cardiovasc Interv. 2021; 14(24):2685-2694. DOI: 10.1016/j.jcin.2021.09.023. View

18.

Sieira J, Chierchia G, di Giovanni G, Conte G, de Asmundis C, Sarkozy A . One year incidence of iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2013; 25(1):11-5. DOI: 10.1111/jce.12279. View

19.

Holmes Jr D, Kar S, Price M, Whisenant B, Sievert H, Doshi S . Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014; 64(1):1-12. DOI: 10.1016/j.jacc.2014.04.029. View

20.

Linhart M, Werner J, Stockigt F, Kohlmann A, Lodde P, Linneborn L . High rate of persistent iatrogenic atrial septal defect after single transseptal puncture for cryoballoon pulmonary vein isolation. J Interv Card Electrophysiol. 2018; 52(2):141-148. DOI: 10.1007/s10840-018-0352-0. View