Heart failure caused by iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation

An 83-year-old man with no structural heart disease underwent pulmonary vein isolation (PVI) for symptomatic paroxysmal atrial fibrillation (AF). The PVI was successfully performed by cryoballoon ablation with a single transseptal puncture. A 12Fr deflectable sheath and an 8.5Fr long sheath crossed...

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Bibliographic Details
Published in:Journal of cardiology cases 2021-12, Vol.24 (6), p.303-306
Main Authors: Yamagishi, Yasunobu, Oginosawa, Yasushi, Kikuchi, Kan, Muneuchi, Jun, Yagyu, Keishiro, Miyamoto, Taro, Tsukahara, Keita, Ohe, Hisaharu, Kohno, Ritsuko, Abe, Haruhiko
Format: Article
Language:English
Subjects:
Atrial fibrillation
Case Report
Cryoballon ablation
Heart failure
Iatrogenic atrial septal defect
Pulmonary vein isolation
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Summary:An 83-year-old man with no structural heart disease underwent pulmonary vein isolation (PVI) for symptomatic paroxysmal atrial fibrillation (AF). The PVI was successfully performed by cryoballoon ablation with a single transseptal puncture. A 12Fr deflectable sheath and an 8.5Fr long sheath crossed the interatrial septum via the same puncture site. Five months after PVI, the patient was readmitted because of heart failure and recurrence of AF. The echocardiogram showed a large (10.7 × 5.8 mm) iatrogenic atrial septal defect (IASD) at the previous puncture site. Both right-to-left and left-to-right shunts were observed during systole and diastole, respectively. Despite the initiation of optimal medical therapy for heart failure, symptoms were not completely controlled and IASD remained 11 months after PVI. Eventually, he received multiple additional PVI for recurrence of AF and percutaneous transcatheter closure (13 mm disc for 10.9 × 8.9 mm- IASD), then heart failure was controlled with the improvement of the right atrial and ventricular size. Although the induction of heart failure by IASD after PVI is rare, it should be noted as one of the causes, especially after cryoballoon ablation with simultaneous mapping catheter insertion via a single transseptal puncture.
ISSN:1878-5409
1878-5409
DOI:10.1016/j.jccase.2021.05.007