Efficacy of catheter ablation for paroxysmal atrial fibrillation in patients with atrial septal defect: A comparison with transcatheter closure alone

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Abstract

Aims: There is no valid treatment strategy for addressing paroxysmal atrial fibrillation (AF) in patients with unclosed atrial septal defect (ASD). We aimed to assess the efficacy of catheter ablation (CA) compared with transcatheter ASD closure alone for treating pre-existing paroxysmal AF in patients with ASD. Methods and results: Among 908 patients who underwent transcatheter ASD closure, we evaluated 50 consecutive patients (63 ± 12 years) with paroxysmal AF. We compared the AF outcomes of these patients after transcatheter ASD closure between those with and without CA prior to ASD closure. Thirty (60%) patients underwent CA. During the follow-up period after ASD closure (mean: 49 ± 23 months), recurrence of AF was observed in 6/30 (20%) patients with upfront CA and 12/20 (60%) patients with ASD closure alone. Kaplan-Meier analysis showed that the AF-free survival rate was significantly higher for patients with CA than for those with ASD closure alone (79% vs. 37% at 5 years, P = 0.002). Upfront CA and previous heart failure hospitalization were associated with recurrence of AF after ASD closure [hazard ratio (HR) 0.18, 95% confidence interval (CI) 0.06-0.53; P = 0.002 and HR 4.64, 95% CI 1.60-13.49; P = 0.005, respectively]. Conclusion: In ASD patient with paroxysmal AF, transcatheter ASD closure alone demonstrated high AF recurrence rate after ASD closure. On the other hand, upfront CA prior to ASD closure substantially suppressed AF recurrence over the long term. A combination of CA and transcatheter ASD closure may be a feasible treatment strategy for paroxysmal AF in patients with ASD.

Original languageEnglish
Pages (from-to)1663-1669
Number of pages7
JournalEuropace
Volume21
Issue number11
DOIs
Publication statusPublished - Nov 1 2019

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Catheter Ablation
Atrial Heart Septal Defects
Atrial Fibrillation
Recurrence
Confidence Intervals
Kaplan-Meier Estimate

Keywords

  • Atrial fibrillation
  • Atrial septal defect
  • Catheter ablation
  • Long-term outcome
  • Pulmonary vein isolation
  • Transcatheter closure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{abb8fa0a86724beea76122786ae8ae33,
title = "Efficacy of catheter ablation for paroxysmal atrial fibrillation in patients with atrial septal defect: A comparison with transcatheter closure alone",
abstract = "Aims: There is no valid treatment strategy for addressing paroxysmal atrial fibrillation (AF) in patients with unclosed atrial septal defect (ASD). We aimed to assess the efficacy of catheter ablation (CA) compared with transcatheter ASD closure alone for treating pre-existing paroxysmal AF in patients with ASD. Methods and results: Among 908 patients who underwent transcatheter ASD closure, we evaluated 50 consecutive patients (63 ± 12 years) with paroxysmal AF. We compared the AF outcomes of these patients after transcatheter ASD closure between those with and without CA prior to ASD closure. Thirty (60{\%}) patients underwent CA. During the follow-up period after ASD closure (mean: 49 ± 23 months), recurrence of AF was observed in 6/30 (20{\%}) patients with upfront CA and 12/20 (60{\%}) patients with ASD closure alone. Kaplan-Meier analysis showed that the AF-free survival rate was significantly higher for patients with CA than for those with ASD closure alone (79{\%} vs. 37{\%} at 5 years, P = 0.002). Upfront CA and previous heart failure hospitalization were associated with recurrence of AF after ASD closure [hazard ratio (HR) 0.18, 95{\%} confidence interval (CI) 0.06-0.53; P = 0.002 and HR 4.64, 95{\%} CI 1.60-13.49; P = 0.005, respectively]. Conclusion: In ASD patient with paroxysmal AF, transcatheter ASD closure alone demonstrated high AF recurrence rate after ASD closure. On the other hand, upfront CA prior to ASD closure substantially suppressed AF recurrence over the long term. A combination of CA and transcatheter ASD closure may be a feasible treatment strategy for paroxysmal AF in patients with ASD.",
keywords = "Atrial fibrillation, Atrial septal defect, Catheter ablation, Long-term outcome, Pulmonary vein isolation, Transcatheter closure",
author = "Koji Nakagawa and Teiji Akagi and Satoshi Nagase and Yoichi Takaya and Yasufumi Kijima and Norihisa Toh and Atsuyuki Watanabe and Nobuhiro Nishii and Kazufumi Nakamura and Hiroshi Morita and Kengo Kusano and Hiroshi Ito",
year = "2019",
month = "11",
day = "1",
doi = "10.1093/europace/euz207",
language = "English",
volume = "21",
pages = "1663--1669",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "11",

}

TY - JOUR

T1 - Efficacy of catheter ablation for paroxysmal atrial fibrillation in patients with atrial septal defect

T2 - A comparison with transcatheter closure alone

AU - Nakagawa, Koji

AU - Akagi, Teiji

AU - Nagase, Satoshi

AU - Takaya, Yoichi

AU - Kijima, Yasufumi

AU - Toh, Norihisa

AU - Watanabe, Atsuyuki

AU - Nishii, Nobuhiro

AU - Nakamura, Kazufumi

AU - Morita, Hiroshi

AU - Kusano, Kengo

AU - Ito, Hiroshi

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Aims: There is no valid treatment strategy for addressing paroxysmal atrial fibrillation (AF) in patients with unclosed atrial septal defect (ASD). We aimed to assess the efficacy of catheter ablation (CA) compared with transcatheter ASD closure alone for treating pre-existing paroxysmal AF in patients with ASD. Methods and results: Among 908 patients who underwent transcatheter ASD closure, we evaluated 50 consecutive patients (63 ± 12 years) with paroxysmal AF. We compared the AF outcomes of these patients after transcatheter ASD closure between those with and without CA prior to ASD closure. Thirty (60%) patients underwent CA. During the follow-up period after ASD closure (mean: 49 ± 23 months), recurrence of AF was observed in 6/30 (20%) patients with upfront CA and 12/20 (60%) patients with ASD closure alone. Kaplan-Meier analysis showed that the AF-free survival rate was significantly higher for patients with CA than for those with ASD closure alone (79% vs. 37% at 5 years, P = 0.002). Upfront CA and previous heart failure hospitalization were associated with recurrence of AF after ASD closure [hazard ratio (HR) 0.18, 95% confidence interval (CI) 0.06-0.53; P = 0.002 and HR 4.64, 95% CI 1.60-13.49; P = 0.005, respectively]. Conclusion: In ASD patient with paroxysmal AF, transcatheter ASD closure alone demonstrated high AF recurrence rate after ASD closure. On the other hand, upfront CA prior to ASD closure substantially suppressed AF recurrence over the long term. A combination of CA and transcatheter ASD closure may be a feasible treatment strategy for paroxysmal AF in patients with ASD.

AB - Aims: There is no valid treatment strategy for addressing paroxysmal atrial fibrillation (AF) in patients with unclosed atrial septal defect (ASD). We aimed to assess the efficacy of catheter ablation (CA) compared with transcatheter ASD closure alone for treating pre-existing paroxysmal AF in patients with ASD. Methods and results: Among 908 patients who underwent transcatheter ASD closure, we evaluated 50 consecutive patients (63 ± 12 years) with paroxysmal AF. We compared the AF outcomes of these patients after transcatheter ASD closure between those with and without CA prior to ASD closure. Thirty (60%) patients underwent CA. During the follow-up period after ASD closure (mean: 49 ± 23 months), recurrence of AF was observed in 6/30 (20%) patients with upfront CA and 12/20 (60%) patients with ASD closure alone. Kaplan-Meier analysis showed that the AF-free survival rate was significantly higher for patients with CA than for those with ASD closure alone (79% vs. 37% at 5 years, P = 0.002). Upfront CA and previous heart failure hospitalization were associated with recurrence of AF after ASD closure [hazard ratio (HR) 0.18, 95% confidence interval (CI) 0.06-0.53; P = 0.002 and HR 4.64, 95% CI 1.60-13.49; P = 0.005, respectively]. Conclusion: In ASD patient with paroxysmal AF, transcatheter ASD closure alone demonstrated high AF recurrence rate after ASD closure. On the other hand, upfront CA prior to ASD closure substantially suppressed AF recurrence over the long term. A combination of CA and transcatheter ASD closure may be a feasible treatment strategy for paroxysmal AF in patients with ASD.

KW - Atrial fibrillation

KW - Atrial septal defect

KW - Catheter ablation

KW - Long-term outcome

KW - Pulmonary vein isolation

KW - Transcatheter closure

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U2 - 10.1093/europace/euz207

DO - 10.1093/europace/euz207

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JO - Europace

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SN - 1099-5129

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