Transseptal access and atrial fibrillation ablation guided by intracardiac echocardiography in patients with atrial septal closure devices

Pasquale Santangeli, Luigi Di Biase, J. David Burkhardt, Rodney Horton, Javier Sanchez, Shane Bailey, Jason D. Zagrodzky, Dhanunjaya Lakkireddy, Rong Bai, Prasant Mohanty, Salwa Beheiry, Richard Hongo, Andrea Natale

Research output: Contribution to journalArticlepeer-review

91 Scopus citations


Background: Percutaneous positioning of closure devices is a well-established treatment of atrial septal defects (ASDs). However, patients who have undergone the procedure are at increased risk for developing atrial fibrillation (AF), and treatment by catheter ablation is underutilized due to the perceived difficulty of obtaining transseptal access in the presence of the closure device. Objective: The purpose of this study was to report the acute and long-term results of radiofrequency catheter ablation of AF in patients with ASD closure devices. Methods: Thirty-nine patients (age 54 ± 6 years, 72% males) with drug-refractory AF (33% paroxysmal, 51% persistent, 16% long-standing persistent) and ASD closure devices (82% Amplatzer, 18% CardioSEAL) underwent radiofrequency catheter ablation. A double transseptal access guided by intracardiac echocardiography was obtained in all patients. Results: In 35 of 39 patients (90%), the transseptal access was obtained in a portion of the native septum, whereas in 4 of 39 patients (10%), a direct access through the device was required. The latter group had a significantly longer time for achieving the double transseptal access (73.6 ± 1.1 minutes vs 4.3 ± 0.4 minutes, P <.001), longer fluoroscopy time (122 ± 5 minutes vs 80 ± 8 minutes, P <.001), and total procedural time (4.1 ± 0.2 hours vs 3.1 ± 0.3 hours, P <.001). At follow-up of 14 ± 4, months the overall success rate was 77% (85% in paroxysmal AF, 73% in nonparoxysmal AF). Transthoracic contrast-enhanced echocardiography with the Valsalva maneuver, performed between 3 and 6 months after the procedure, failed to detect shunt in all patients. Conclusion: Radiofrequency catheter ablation of AF is feasible, safe, and effective in patients with ASD closure devices. Transseptal access can be obtained in portions of the native septum in the majority of cases. Direct transseptal puncture of the device is feasible and safe but requires longer time for each transseptal access.

Original languageEnglish (US)
Pages (from-to)1669-1675
Number of pages7
JournalHeart Rhythm
Issue number11
StatePublished - Nov 2011
Externally publishedYes


  • Atrial fibrillation
  • Atrial septal defect
  • Catheter ablation
  • Closure device
  • Transseptal puncture

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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