Page 83 - BH-3-3

Brain & Heart

CASE SERIES
Intracardiac echocardiography-guided

transseptal puncture in anteroinferior native
septum site for patients undergoing atrial

fibrillation ablation with atrial septal closure
devices: A case series

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Evan Jim Gunawan 1,2 , Hui Chai , Zhanyang Wei , Le Li , Zhicheng Hu ,
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1
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LiKun Zhou , Yu Xia , Xu Meng , Lingmin Wu , Lihui Zheng , Ligang Ding * ,
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1
1
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and Yan Yao 1
1 National Center for Cardiovascular Diseases, Fu Wai Hospital, Peking Union Medical College,
Chinese Academy of Medical Sciences, Beijing, China
2 Department of Cardiovascular, Binawaluya Hospital Cardiac Centre, Jakarta, Indonesia
3 Department of Cardiovascular, The First People’s Hospital of Lanzhou City, Lanzhou, China
4 Department of Cardiovascular, Dongguan People’s Hospital, Guangdong, China
Abstract
*Corresponding author:
Ligang Ding This case series describes the safety and feasibility of an anteroinferior transseptal
(ligangding@263.net) puncture (TSP) in patients implanted with atrial septal defect (ASD) closure devices
Citation: Gunawan EJ, Chai H, for atrial fibrillation (AF) ablation. Eight AF ablation procedures were performed in
Wei Z, et al. Intracardiac seven patients (58.4 ± 8.7 years; two males) with symptomatic AF and percutaneous
echocardiography-guided
transseptal puncture in ASD closure. Typically, the TSP site for patients with an ASD closure device is located
anteroinferior native septum site for in the inferior-posterior region of the native septum. However, with larger devices
patients undergoing atrial fibrillation (>26 mm), limited space in this area can pose challenges for transseptal access. Using
ablation with atrial septal closure
devices: A case series. Brain & transthoracic echocardiography and 3D cardiac computed tomography, TSP sites
Heart. 2025;3(3):5119. were pre-determined, targeting the anteroinferior native septum. Closure device
doi: 10.36922/bh.5119 diameters averaged 23.8 ± 10.8 mm (range: 10 – 40 mm), with five cases involving
Submitted: October 10, 2024 devices ≥26 mm. The procedures were guided by fluoroscopy and intracardiac
echocardiography, achieving a 100% success rate without TSP-related complications.
Revised: November 15, 2024
These findings suggest the anteroinferior TSP approach is a safe and viable alternative
Accepted: November 27, 2024 for patients with large ASD closure devices.
Published online: December 10,
2024
Keywords: Atrial septal defect; Atrial septal closure device; Transseptal puncture; Atrial
Copyright: © 2024 Author(s). fibrillation; Ablation
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution,
and reproduction in any medium, 1. Introduction
provided the original work is
properly cited. Patients with atrial septal defect (ASD) after percutaneous closure remain at an increased
1
Publisher’s Note: AccScience risk for having atrial fibrillation (AF) with an annual incidence of 4.1%. AF ablation in
Publishing remains neutral with these patients presents challenges, especially with an enlarged atrium and with a long
regard to jurisdictional claims in
published maps and institutional history of AF. Catheter ablation usually is avoided because of the transseptal access in
affiliations. the presence of an atrial septum closure device. Although transseptal puncture (TSP)

Volume 3 Issue 3 (2025) 1 doi: 10.36922/bh.5119