Natural Outcome Of Iatrogenic Atrial Septal Defect After Radiofrequency Ablation Therapy

Objective: The study aims at understanding the healing of iatrogenic atrial septal defect caused by atrial septal puncturing to place two sheathing canals with one-time puncture during the treating process of patients with auricular fibrillation. The healing factors influencing the healing of iatrogenic atrial septal defect caused by atrial septal puncturing method were discussed, and at the same time, the safety and reliability of placing two sheathing canals with one-time puncture were verified, in order to provide references to puncture method selection in radiofrequency ablation therapy and data support for determining the condition and healing time of atrial septal defect caused by radiofrequency ablation therapy.Method:A total of 34 cases patients with auricular fibrillation who have received radiofrequency ablation therapy in our hospital from June 2014 to June 2015 were selected. The information of patient, including gender, age and weight etc., were collected. Esophageal ultrasound detection was conducted before surgery. The thickness of atrial septal was recorded to exclude the preexisted atrial septal defect (including congenital atrial septal defects and old-type congenital atrial septal defects). Completing the pre operation preparation and making sure all the patients have no surgical contraindication. In operation, the puncture was carried out through left subclavicular vein, then the placement of 6F sheathing canals and the 10 coronary sinus electrode. The 0.032# long guide wire were successively delivered during the second puncture,one of which was sent into the right atrium via the heart of swartz sheath, and then sent into the puncture needle with its end arrow direction towards five o’clock under positive perspective, drag slowly from top to bottom. When feeling the jump of the sheath heart, fixed the sheath heart and puncture needle,changed the perspective position to right anterior obliquity with 45°, rotated the puncture needle to be parallel to the spine, and then picked out the needle. Fixed the puncture needle after blood extraction, sent the sheath heart a little bit forward (avoid to send the sheath heart and puncture needle too deep to injure the atrial wall.) withdrew puncture needle and sent the long guide wire into superior left pulmonary vein, and then withdrew the sheath heart. After sent the 8F agilis sheath to the atrial septum dilatation via this guide wire, then withdrew from the left atrium. Using another guide wire to send 8F swartz sheath and large-tip electrode to the right atrium, sent the large-tip electrode into left atrium through the port site of expanded interatrial septum, and then sent the lasso electrode and cold-saline-large-tip electrode to the left atrium via 8F Swartz sheath and 8F agilis sheath. Finished the circumferential pulmonary vein operation. Conducted the esophageal ultrasound examination in postoperative 24h and 3 respectively, recording the atrial septal thickness as well as atrial septal defect area. The evolvement of defect area in postoperative 24h and 3 month were analyzed by paired-samples t test, and the healing possibility and healing time of iatrogenic atrial septal defect caused by atrial septal puncture were determined. The thickness of foreman ovale before and in 3 month after operation was also examined using paired-samples t test to observe the connection with the healing of iatrogenic atrial septal defectResults:In three months after operation, 23 cases iatrogenic atrial septal defect were healed naturally, accounting for 79.3%. And among the 23 cases,there were five cases naturally healed in 48h after operation. All of the patients showed remarkable decrease in atrial septal defect area(P<0.001 ). There is no sever complications occurred in operation, such as pericardial effusion and pericardial tamponade, etc. The thickness of foreman ovale in 3 month after operation showed no obvious association with the thickness before surgery(P=0.335).Conclusion: Iatrogenic atrial septal defect caused by atrial septal puncturing to place two sheathing canals with one-time puncture during the treating process of patients with auricular fibrillation showed obvious healing tendency. The healing process had no apparent effect on the thickness of the foreman ovale. The research subjects had no sever complication in atrial septal puncture operation of radiofrequency ablation therapy, having high safety to patients.