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Updated: Jun 26, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Transcatheter closure of atrial septal defect in elderly patients with permanent atrial fibrillation
Manabu Taniguchi1, Teiji Akagi, Shinichi Ohtsuki
1Division of Cardiac Care Unit, Okayama University Hospital, Okayama, Japan. tmnb@md.okayama-u.ac.jp
Insights
Device closure of atrial septal defect (ASD) is feasible and effective in elderly patients with permanent atrial fibrillation. This procedure improves cardiac function and reduces symptoms, even with pre-existing arrhythmias.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Atrial septal defect (ASD) closure in elderly patients with permanent atrial fibrillation is not well-studied.
- Understanding the feasibility and outcomes of device closure in this specific population is crucial.
Purpose of the Study:
- To evaluate the feasibility and efficacy of transcatheter device closure for atrial septal defects (ASDs) in elderly individuals.
- To assess the impact of ASD device closure on cardiac function and symptoms in patients with permanent atrial fibrillation.
Main Methods:
- Nine elderly patients with persistent atrial fibrillation underwent transcatheter ASD closure using the Amplatzer septal occluder.
- Transthoracic echocardiography and B-type natriuretic peptide (BNP) levels were monitored pre- and post-procedure.
- Patients continued their pre-existing medication regimens, including warfarin and diuretics.
Main Results:
- Successful ASD device closure was achieved in all patients without immediate complications.
- Significant improvements were observed in New York Heart Association (NYHA) functional classification and resting heart rate.
- Cardiac geometric remodeling, evidenced by improved right/left ventricular diameter ratio and reduced plasma BNP levels, was noted post-closure.
Conclusions:
- Transcatheter closure of ASD is a feasible and effective treatment option for elderly patients, even those with permanent atrial fibrillation.
- Device closure leads to symptomatic improvement and favorable cardiac structural changes, enhancing quality of life.
Objectives:
The aim of this study is to evaluate the feasibility and efficacy of device closure of atrial septal defect (ASD) in elderly patients with permanent atrial fibrillation.
Background:
Little is known about the feasibility of device closure of ASD in those patients.
Methods:
Nine consecutive patients (mean age 68.1 years) with permanent atrial fibrillation (>1 year persistent) underwent catheter closure using the Amplatzer septal occluder. Transthoracic echocardiography and plasma B-type natriuretic peptide (BNP) level were assessed before and at 24 hours; and 1, 3, and >6 months after the closure. Before the procedure, appropriate dose of warfarin was used in all, diuretics was used in 8/9. Same amount of medications were continued after the procedure.
Results:
ASD could be closed in all (mean device size 27.3 mm) without hemodynamic and thromboembolic complications. New York Heart Association (NYHA) functional classification was significantly improved in all patients after device closure. No hemodynamic and thromboembolic complications were observed during the follow-up period (mean 10.6 months). Although permanent atrial fibrillation did not change in all after the procedure, resting heart rate decreased from 76.2 +/- 16.0 to 68.3 +/- 13.2 beats/min (P = 0.015). There was statistically significant improvement in right ventricular/left ventricular diameter ratio (1.08 +/- 0.16 to 0.73 +/- 0.10, P = 0.008) and plasma BNP level (183.7 +/- 90.5 to 94.6 +/- 47.4 pg/mL, P = 0.008) after >6 months device closure.
Conclusions:
Even in the patients complicated with permanent fibrillation, transcatheter closure of ASD can contribute to symptomatic improvement as well as cardiac geometric remodeling.
