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Iatrogenic atrial septal defects after transseptal puncture for percutaneous left atrial appendage occlusion and
Ioannis Drosos1, Roberta De Rosa1, Philipp C Seppelt1
1Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany.
Insights
Percutaneous left atrial appendage occlusion creates small atrial septal defects. These defects do not cause significant shunting immediately after the procedure, though right atrial pressure increases. Persistent defects are rare at three months.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Percutaneous left atrial appendage occlusion (LAAO) necessitates interatrial septum puncture.
- The hemodynamic impact of iatrogenic atrial septal defects (iASD) post-LAAO remains understudied.
- Immediate hemodynamic effects and persistent iASD incidence require investigation.
Purpose of the Study:
- To evaluate immediate hemodynamic effects of iASD after LAAO using invasive pressure and oxygen saturation measurements.
- To assess the incidence of persistent iASD at three months post-LAAO.
Main Methods:
- Prospective study of 48 patients undergoing percutaneous LAAO.
- Invasive pressure and oxygen saturation measurements in right and left atria at various procedural stages.
- Transesophageal echocardiography at three months to detect persistent iASD.
Main Results:
- A significant increase in mean right atrial pressure was observed post-sheath removal (P = 0.034).
- No significant changes in left atrial pressure or oxygen saturation in either atrium were detected.
- Persistent iASD was identified in 8.5% of patients at three-month follow-up.
Conclusions:
- Iatrogenic atrial septal defects post-LAAO do not typically cause significant immediate shunting.
- A notable increase in mean right atrial pressure occurs post-procedure.
- Persistent iASDs are uncommon at three months following LAAO.
Background:
Percutaneous left atrial appendage occlusion (LAAO) requires puncture of the interatrial septum. The immediate hemodynamic effects of iatrogenic atrial septal defects (iASD) after LAAO have not been examined so far. We aimed at evaluating these effects through invasive measurements of pressure and oxygen saturation. Moreover, we assessed the incidence of persistent iASD at three months.
Methods:
Forty-eight patients scheduled for percutaneous LAAO were prospectively included in the study. Pressure and oxygen saturation were measured (1) in the right atrium (RA) before transseptal puncture, (2) in the left atrium (LA) through the transseptal sheath after transseptal puncture, (3) in the LA after removal of introducer sheath, and (4) in the RA after removal of introducer sheath. Transesophageal echocardiography was performed at three months to detect iASD.
Results:
Pressure in the RA increased significantly after removing the introducer sheath (P = 0.034), whereas no difference was found in oxygen saturation in the RA (P = 0.623). Pressure measurement in the LA showed no significant difference after removing the introducer sheath (P = 0.718). Oxygen saturation in the LA also showed no significant difference (P = 0.129). Follow-up transesophageal echocardiogram at 3 months revealed a persistent iASD in 4 patients (8.5 %).
Conclusions:
Our study suggests that iASD after percutaneous LAAO does not result in significant shunts directly after the procedure, although a significant increase of mean right atrial pressure can be observed. Persistent iASDs after percutaneous LAAO seem to be relatively rare at three months.
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