Key result
Transseptal puncture and left atrial ablation were successfully and safely performed infero-posterior to an implanted atrial flow regulator in an 80-year-old woman.
Why the study?
Is transseptal puncture for left atrial ablation safe and feasible in a patient with an implanted atrial flow regulator?
Case Report (n=1)
Is transseptal puncture for left atrial ablation safe and feasible in a patient with an implanted atrial flow regulator?
This case demonstrates that transseptal puncture for left atrial ablation is feasible and safe in patients with an implanted atrial flow regulator when performed infero-posterior to the device.
May support targeted feasibility infero-posterior to atrial flow regulators; leaves open systematic safety evaluation.
Background Atrial flow regulator (AFR) (Occlutech, Helsingborg, Sweden) are self-expanding, circular devices. A flexible waist in the centre connects the two discs and has a centrally located shunt. Case summary We report a case of an 80-year-old woman undergoing a repeat left atrial ablation for persistent atrial fibrillation with an implanted AFR. The AFR was implanted 1 year prior to the procedure for heart failure with preserved ejection fraction as part of the AFR-PRELIEVE trial. A single, fluoroscopy-guided, transseptal puncture was performed infero-posterior to the device, allowing the positioning of the mapping (LASSO® 20 mm, Biosense Webster, Irvine, CA, USA) and ablation (Thermocool Smarttouch SF, CARTO®, Biosense Webster, Irvine, CA, USA) catheter in the left atrium. Three-dimensional mapping (CARTO®, Biosense Webster, Irvine, CA, USA) and left atrial ablation were successfully performed. After the procedure, fluoroscopy and transthoracic echocardiography showed an unchanged device position. Discussion To our knowledge, this is the first case report of a transseptal puncture in a patient with an implanted AFR. Transseptal puncture in patients with an implanted AFR seems to be safe and feasible. With device diameters of 21–23 mm and based on previous studies on similar devices, transseptal puncture should be possible in most patients, as opposed to puncture through the device.
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Biller et al. (2020) conducted a case report in Persistent atrial fibrillation with an implanted atrial flow regulator (n=1). Transseptal puncture infero-posterior to the implanted atrial flow regulator was evaluated on Feasibility and safety of transseptal puncture and left atrial ablation. Transseptal puncture and left atrial ablation were successfully and safely performed infero-posterior to an implanted atrial flow regulator in an 80-year-old woman.
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