Persistence of septal defects after transeptal puncture for pulmonary vein isolation procedures

Pulmonary vein isolation (PVI) is widely practiced as a means of potentially curing atrial fibrillation (AF). Transeptal puncture is performed for PVI procedures, often two such punctures are performed. We sought to examine the prevalence of medium- to long- term iatrogenic septal defects after such procedures. Thirty-one patients who were undergoing their second PVI procedure were studied with transesophageal echocardiography (TEE) with two-dimensional imaging and color Doppler, examining the fossa ovalis for defects. Mean time from the original PVI to the time of TEE was 35 weeks. Two patients were discovered to have iatrogenic septal defects. The interval between the first PVI procedure and the TEE showing a septal defect was 33.7 weeks in one patient and 14.3 weeks in the other. Iatrogenic septal defects may occur in the medium- to long-term in patients undergoing PVI procedures for AF. The clinical implications of such defects are unknown.