Iatrogenic atrial septal defects after transseptal puncture for percutaneous left atrial appendage occlusion and their hemodynamic effects

Ioannis Drosos; Roberta De Rosa; Philipp C Seppelt; Sebastian Cremer; Silvia Mas-Peiro; Katrin Hemmann; Jana Oppermann; Recha Blessing; Mariuca Vasa-Nicotera; Andreas M Zeiher; Zisis Dimitriadis

doi:10.11909/j.issn.1671-5411.2022.09.009

Iatrogenic atrial septal defects after transseptal puncture for percutaneous left atrial appendage occlusion and their hemodynamic effects

J Geriatr Cardiol. 2022 Sep 28;19(9):675-684. doi: 10.11909/j.issn.1671-5411.2022.09.009.

Authors

Affiliations

¹ Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany.
² German Center for Cardiovascular Research (DZHK), Berlin, Germany.
³ Cardiopulmonary Institute (CPI), Frankfurt, Germany.
⁴ Center of Cardiology, University Medical Center Mainz, Mainz, Germany.
⁵ Division of Cardiology and Intensive Care, Department of Internal Medicine, St. Ansgar Hospital, Höxter, Germany.

PMID: 36284683
PMCID: PMC9548059
DOI: 10.11909/j.issn.1671-5411.2022.09.009

Abstract

Background: Percutaneous left atrial appendage occlusion (LAAO) requires puncture of the interatrial septum. The immediate hemodynamic effects of iatrogenic atrial septal defects (iASD) after LAAO have not been examined so far. We aimed at evaluating these effects through invasive measurements of pressure and oxygen saturation. Moreover, we assessed the incidence of persistent iASD at three months.

Methods: Forty-eight patients scheduled for percutaneous LAAO were prospectively included in the study. Pressure and oxygen saturation were measured (1) in the right atrium (RA) before transseptal puncture, (2) in the left atrium (LA) through the transseptal sheath after transseptal puncture, (3) in the LA after removal of introducer sheath, and (4) in the RA after removal of introducer sheath. Transesophageal echocardiography was performed at three months to detect iASD.

Results: Pressure in the RA increased significantly after removing the introducer sheath (P = 0.034), whereas no difference was found in oxygen saturation in the RA (P = 0.623). Pressure measurement in the LA showed no significant difference after removing the introducer sheath (P = 0.718). Oxygen saturation in the LA also showed no significant difference (P = 0.129). Follow-up transesophageal echocardiogram at 3 months revealed a persistent iASD in 4 patients (8.5 %).

Conclusions: Our study suggests that iASD after percutaneous LAAO does not result in significant shunts directly after the procedure, although a significant increase of mean right atrial pressure can be observed. Persistent iASDs after percutaneous LAAO seem to be relatively rare at three months.