Percutaneous Closure of Persistent Atrial Septal Defects After Pulmonary Vein Isolation
Highlights
- • Majority of post PVI atrial septal defects (ASD) close spontaneously at 3–6 mo.
- • Cryoballoon ablation technique is more commonly associated with persistent ASD.
- • Significant iatrogenic ASD after PVI requiring closure is rare.
- • Post PVI ASD needs to be evaluated in patients with deteriorating hemodynamics.
- • Percutaneous iASD closure is easy and safe.
Abstract
Pulmonary vein isolation (PVI) with radiofrequency or cryoballoon ablation to treat atrial fibrillation requires trans-septal puncture. This creates a small iatrogenic atrial septal defect (iASD). In most patients, the defect spontaneously closes after 3–6 months. However, persistent iASDs can cause hemodynamic changes and adverse consequences from inter-atrial shunting. Persistent post PVI iASDs that are clinically significant can be closed percutaneously. This diagnosis should be considered in patients with worsening dyspnea or fatigue after PVI. We present a case of post PVI iASDs causing immediate or late onset hemodynamic changes and clinical symptoms, which improved after ASD closure. We provide a review of previously reported cases and literature on post PVI ASD prevalence, risk factors and outcomes after ASD closure.