Thoracoscopic pulmonary vein isolation after previous percutaneous atrial septal defect closure
Noriyuki Matsutani1, Richard Lee, Jennifer O'Leary
1Department of Surgery II, National Defense Medical College, Namiki, Tokorozawa, Saitama, Japan.
Insights
Atrial fibrillation (AF) is common in older adults with atrial septal defect (ASD). Thoracoscopic pulmonary vein isolation offers a minimally invasive option for AF treatment in patients with existing ASD closure devices.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a significant cause of morbidity in patients over 40 with atrial septal defect (ASD).
- Conventional atrial septal defect closure may preclude future transseptal catheter interventions.
- Surgical epicardial pulmonary vein isolation is effective for AF treatment.
Observation:
- This case report details a thoracoscopic-assisted pulmonary vein isolation procedure.
- The patient had a pre-existing atrial septal occlusion device.
- This approach was utilized in a minimally invasive manner via bilateral thoracotomies.
Findings:
- Thoracoscopic-assisted pulmonary vein isolation is a feasible technique in patients with prior atrial septal occlusion devices.
- This minimally invasive approach provides an alternative for AF management in this specific patient population.
Implications:
- This technique may preserve future transseptal access options.
- Minimally invasive epicardial ablation offers a viable strategy for AF treatment in patients with ASD devices.
- Further research is warranted to evaluate long-term outcomes.
Abstract:
Atrial fibrillation (AF) is the main cause of morbidity among patients over 40 years of age with atrial septal defect (ASD). The closure of ASD in older patients does not decrease the occurrence of AF.(1-3) However, percutaneous ASD closure devices eliminate the possibility of a transseptal approach for future catheter-based procedures such as AF ablation. Epicardial pulmonary vein isolation with a bipolar radiofrequency clamp has been shown to be a safe and effective practice in surgical treatment of AF.(4,5) More recently, this technology has been utilized in a minimally invasive approach through bilateral thoracotomies. We present the case of a thoracoscopic-assisted pulmonary vein isolation on a patient with an atrial septal occlusion device.
