Related Experiment Video

Updated: Jul 10, 2026

Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter
08:00

Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter

Published on: June 15, 2015

Clinical significance of persistent iatrogenic atrial septal defect after catheter ablation for atrial fibrillation

Kazuki Shimojo1, Itsuro Morishima1, Yasuhiro Morita1

  • 1Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.

Heart Rhythm
|July 8, 2026
PubMed

Insights

Persistent iatrogenic atrial septal defect (iASD) after atrial fibrillation ablation is linked to worse outcomes. This complication may indicate a higher risk of cardiovascular mortality and heart failure hospitalization post-procedure.

Area of Science:

  • Cardiology
  • Medical Devices
  • Interventional Cardiology

Background:

  • Iatrogenic atrial septal defect (iASD) is a common complication following catheter ablation (CA) for atrial fibrillation (AF).
  • The clinical significance and prognostic implications of persistent iASD after AF ablation remain incompletely understood.

Purpose of the Study:

  • To investigate the association between persistent iASD and AF recurrence.
  • To evaluate the relationship of persistent iASD with major adverse clinical outcomes after AF ablation in a comprehensive cohort and a specific subgroup.

Main Methods:

  • Retrospective analysis of 1,288 patients undergoing first-time CA for AF (2012-2022).
  • Transthoracic echocardiography performed pre-ablation and 3 months post-ablation to assess iASD.
  • Evaluation of a subgroup (n=578) using contact force radiofrequency ablation with a standardized two-sheath transseptal approach.

Main Results:

  • Persistent iASD was detected in 9.9% of patients.
  • Unadjusted analysis showed higher AF recurrence in patients with iASD (p=0.002 overall, p=0.004 subgroup), but this was not significant after multivariable adjustment.
  • Persistent iASD was associated with increased cardiovascular mortality (p=0.02) and heart failure hospitalization (p<0.001), particularly in the early phase post-ablation. Ischemic stroke risk was not significantly different (p=0.28).

Conclusions:

  • Persistent iASD after AF ablation is linked to increased cardiovascular mortality and early heart failure hospitalizations.
  • While not independently predicting AF recurrence in multivariable analysis, persistent iASD may serve as a valuable clinical marker for adverse prognosis following AF ablation.
Abstract

Keywords:
Atrial fibrillationCatheter ablationHeart failureIatrogenic atrial septal defectSheath size

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