• Dhanunjaya Lakkireddy, Umamahesh Rangisetty, Subramanya Prasad, Atul Verma, Mazda Biria, Loren Berenbom, Rhea Pimentel, Martin Emert, Thomas Rosamond, Tamer Fahmy, Dimpi Patel, Luigi Di Biase, Robert Schweikert, David Burkhardt, and Andrea Natale.
• Mid-America Cardiology at the University of Kansas Hospital, Kansas City, Kansas, USA.
• J. Cardiovasc. Electrophysiol. 2008 Nov 1; 19 (11): 1137-42.

UnlabelledIntracardiac Echo-Guided Radiofrequency Catheter.IntroductionPatients with atrial septal defect (ASD) are at higher risk for atrial fibrillation (AF) even after repair. Transseptal access in these patients is perceived to be difficult. We describe the feasibility, safety, and efficacy of pulmonary vein antral isolation (PVAI) in these patients.MethodWe prospectively compared post-ASD/patent foramen ovale (PFO) repair patients (group I, n = 45) with age-gender-AF type matched controls (group II, n = 45). All the patients underwent PVAI through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography (ICE). The short-term (3 months) and long-term (12 month) failure rates were assessed.ResultsIn group I, 23 (51%) had percutaneous closure devices and 22 (49%) had a surgical closure. There was no significant difference between group I and II in the baseline characteristics. Intracardiac echo-guided double transseptal access was obtained in 98% of patients in group I and in 100% of patients in group II. PVAI was performed in all patients, with right atrial flutter ablation in 7 patients in group I and in 4 patients in group II. Over a mean follow-up of 15 +/- 4 months, group I had higher short-term (18% vs 13%, P = 0.77) and long-term recurrence (24% vs 18%, P = 0.6) than group II. There was no significant difference in the perioperative complications between the two groups. Echocardiography at 3 months showed interatrial communication in 2 patients in group I and 1 patient in group II, which resolved at 12 months.ConclusionPercutaneous AF ablation using double transseptal access is feasible, safe, and efficacious in patients with ASD and PFO repairs.

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