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Iatrogenic atrial septal defect after percutaneous left atrial appendage closure: a single-center study

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Abstract

There is conflicting evidence regarding the significance of iatrogenic atrial septal defects (iASDs) after transseptal puncture during percutaneous cardiac interventions. To study the clinical outcome of iASD after percutaneous left atrial appendage occlusion (LAAo). Single-center, retrospective study of 70 consecutive patients who underwent percutaneous LAAo between May 2010 and August 2017, and subsequent transesophageal echocardiography (TEE) at 1 month. The sample population was divided into two groups: A (with iASD, 22 (37%) patients) and B (no iASD, 44 (63%) patients). Procedures were guided either by TEE (36 patients (54%)) or intracardiac echocardiography (ICE) from the left atrium (30 patients (46%)). The primary end point was presence of iASD at 1 month, and secondary end points included mortality, hospital admission due to heart failure (HF), and right atrium (RA) size during follow-up. 70 patients were included in this study and the prevalence of iASD at 1 month was 37%. The use of ICE was associated with iASD (adjusted odds ratio, 3.79; 95% CI 1.27–11.34). The presence of iASD was not associated with adverse events (mortality, 15.4% vs 20.5%; P = 0.60; HF hospitalizations, 7.7% vs 13.6%, P = 0.45; and RA area, 24.8 ± 7.0 cm2 vs 22.2 ± 6.8 cm2, P = 0.192). At 1-month follow-up after LAAo, iASD was present in one third of patients, but was not associated with clinical outcomes. The use of ICE was associated with a higher risk of short-term iASD.

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Data availability

The datasets and code generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AF:

Atrial fibrillation

ASD:

Atrial septal defect

HF:

Heart failure

iASD:

Iatrogenic atrial septal defect

ICE:

Intracardiac echocardiography

IQR:

Interquartile range

LA:

Left atrium

LAA:

Left atrium appendage

LAAo:

Left atrial appendage occlusion

LVEF:

Left ventricle ejection fraction

PFO:

Patent foramen ovale

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

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Funding

No funds were required for this work.

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Author notes

  1. Luís Puga and Rogério Teixeira contributed equally.

Authors and Affiliations

  1. Cardiology Department, Centro Hospitalar e universitário de Coimbra - Hospital Geral, Quinta dos Vales - São Martinho do Bispo, 3043-853, Coimbra, Portugal

    Luís Puga, Rogério Teixeira, Luís Paiva, Joana Maria Ribeiro, João Gameiro, José Pedro Sousa, Marco Costa & Lino Gonçalves

  2. ICBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Rogério Teixeira & Lino Gonçalves

  3. Cardiology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal

    Joana Maria Ribeiro

Authors
  1. Luís Puga
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  2. Rogério Teixeira
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  3. Luís Paiva
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  4. Joana Maria Ribeiro
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  5. João Gameiro
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  6. José Pedro Sousa
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  7. Marco Costa
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  8. Lino Gonçalves
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Contributions

Conceptualization: LP and RT; Methodology: LP, RT and JR; Formal analysis and investigation: LP, RT, JR, LP, JPS, JG and MC; Writing—original draft preparation: LP and RT; Writing—review and editing: LP, JR, MC and LGs; Supervision: LG.

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Correspondence to Rogério Teixeira.

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The authors declare that they have no conflict of interest.

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This retrospective study was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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All patients provided informed consent.

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Puga, L., Teixeira, R., Paiva, L. et al. Iatrogenic atrial septal defect after percutaneous left atrial appendage closure: a single-center study. Int J Cardiovasc Imaging 37, 2359–2368 (2021). https://doi.org/10.1007/s10554-021-02212-4

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  • DOI: https://doi.org/10.1007/s10554-021-02212-4

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