Key result
Upfront catheter ablation prior to transcatheter ASD closure significantly reduced atrial fibrillation recurrence compared to ASD closure alone (HR 0.18; 95% CI 0.06-0.53; P=0.002).
Why the study?
There is no valid treatment strategy for addressing paroxysmal AF in patients with unclosed ASD.
Does catheter ablation prior to transcatheter ASD closure reduce the recurrence of atrial fibrillation in patients with paroxysmal AF and ASD?
Cohort (n=50)
Does catheter ablation prior to transcatheter ASD closure reduce the recurrence of atrial fibrillation in patients with paroxysmal AF and ASD?
Effect estimate: HR 0.18 (95% CI 0.06-0.53)
Absolute Event Rate: 20% vs 60%
p-value: p=0.002
In patients with ASD and paroxysmal AF, performing catheter ablation prior to transcatheter ASD closure significantly reduces long-term AF recurrence compared to ASD closure alone.
Upfront ablation may lower AF recurrence after ASD closure in paroxysmal AF; leaves open need for RCTs before practice change.
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.
No takes yet. Share an insight, caveat, or question.
Nakagawa et al. (2019) conducted a cohort in Paroxysmal atrial fibrillation in patients with atrial septal defect (n=50). Catheter ablation prior to ASD closure vs. Transcatheter ASD closure alone was evaluated on Recurrence of atrial fibrillation (HR 0.18, 95% CI 0.06-0.53, p=0.002). Upfront catheter ablation prior to transcatheter ASD closure significantly reduced atrial fibrillation recurrence compared to ASD closure alone (HR 0.18; 95% CI 0.06-0.53; P=0.002).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: