July 10, 2025European journal of medical researchOpen Access

Analysis of healing status and influencing factors of iatrogenic atrial septal defect in patients with atrial fibrillation after cryoballoon ablation

Q: What are the key findings of this study?

In patients with non-valvular atrial fibrillation, the incidence of iatrogenic atrial septal defect decreased significantly from 29.0% at 3 months to 9.7% at 12 months after cryoballoon ablation.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Non-valvular atrial fibrillation (n=262). Intervention: Cryoballoon ablation (CBA) vs. 3 months post-operation (baseline for healing). Primary outcome: Incidence of iatrogenic atrial septal defect (IASD) at 12 months compared to 3 months (p=<0.0001).

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Key result

Iatrogenic atrial septal defects drop ~67% from 3 to 12 months after AF cryoballoon ablation.

P<0.0001
n=262

Why the study?

Iatrogenic atrial septal defect may occur after cryoballoon ablation for AF, warranting investigation into its incidence, healing status, risk factors, and clinical significance.

Does cryoballoon ablation for atrial fibrillation lead to persistent iatrogenic atrial septal defects and associated adverse events in patients with non-valvular atrial fibrillation?

Study Design

Type

Cohort (n=262)

Multicenter

Structured PICO

Does cryoballoon ablation for atrial fibrillation lead to persistent iatrogenic atrial septal defects and associated adverse events in patients with non-valvular atrial fibrillation?

Population

262 patients with non-valvular atrial fibrillation (AF) who underwent cryoballoon ablation (CBA) or CBA + left atrial appendage occlusion (LAAO) therapy in Fujian Provincial Hospital from 2021 to 2023.

Intervention

Cryoballoon ablation (CBA) with or without left atrial appendage occlusion (LAAO)

Outcome

Incidence and healing status of iatrogenic atrial septal defect (IASD) at 3, 6, and 12 months postoperatively, assessed by transthoracic echocardiographysurrogate

Main Result

Absolute Event Rate: 9.7% vs 29%

p-value: p=<0.0001

Iatrogenic atrial septal defects are common 3 months after cryoballoon ablation but largely heal spontaneously by 12 months without causing thromboembolic or cardiovascular complications.

Limitations

Single-center, retrospective design
Use of transthoracic echocardiography (TTE) instead of transesophageal echocardiography (TEE) may underestimate IASD incidence
Use of left atrial diameter (LAD) rather than left atrial volume may underestimate the true impact of left atrial enlargement on IASD persistence
Use of transthoracic echocardiography, which is less sensitive than transesophageal echocardiography for detecting defect sizes
Inter-observer variability in defect size measurement

Implication

Most iatrogenic atrial septal defects resolve by 12 months without events; supports expectant management but leaves open larger confirmatory studies.

Abstract

BACKGROUND: Iatrogenic atrial septal defect (IASD) may occur after cryoballoon ablation (CBA) for atrial fibrillation (AF) patients. This study aimed to investigate the incidence and healing status of IASD after CBA, and to analyze the risk factors and clinical significance associated with the occurrence of IASD. METHODS AND RESULTS: Patients with non-valvular AF who underwent CBA in Fujian Provincial Hospital from 2021 to 2023 were continuously enrolled. Then they were divided into IASD and non-IASD groups according to 3-month postoperative transthoracic echocardiography. Among the 262 AF patients, the rate of IASD presence decreased from 29.0 to 9.7% in 12 months after CBA. IASD group had larger left atrial diameters (LAD), longer operation duration, and a higher proportion of hypertension history than the non-IASD group. Multiple Linear Regression (MLR) analyses showed that preoperative LAD and history of hypertension were independently associated with IASD occurrence. During the follow-up period, there were no ischemic strokes, ectopic embolisms, transient ischemic attacks, or other adverse events being observed. CONCLUSIONS: The incidence of IASD after CBA is relatively high, but it generally tends to heal spontaneously. Preoperative LAD and history of hypertension are independent risk factors for postoperative IASD. The clinical outcome of IASD is relatively safe and no serious cardiovascular or cerebrovascular adverse events have been observed.

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Cite This Study

Zeng et al. (2025) conducted a cohort in Non-valvular atrial fibrillation (n=262). Cryoballoon ablation (CBA) vs. 3 months post-operation (baseline for healing) was evaluated on Incidence of iatrogenic atrial septal defect (IASD) at 12 months compared to 3 months (p=<0.0001). In patients with non-valvular atrial fibrillation, the incidence of iatrogenic atrial septal defect decreased significantly from 29.0% at 3 months to 9.7% at 12 months after cryoballoon ablation.

synapsesocial.com/papers/6a0f8aec4fb650da4ffe3cd8 https://doi.org/10.1186/s40001-025-02875-y