Address for Correspondence
Giovanni B. Forleo, MD, PhD
Section Head Electrophysiology and Cardiac Pacing. Azienda Ospedaliera -
Polo Universitario - ”Luigi Sacco”.
Via G.B. Grassi 74, 20157, Milano, Italy.
Office: +39 02 3904 2789 - Fax: +39 02 3904 2311
Email: forleo@me.com
Percutaneous atrial septal defect (ASD) closure is the mainstay
treatment for ostium secundum ASD and patent foramen
ovale1. Patients with ASD may develop atrial
fibrillation (AF), mostly due to structural atrial remodeling creating
the substrate for macroreentry2,3. Timing of ASD
closure is crucial to prevent further development of
electrophysiological heterogeneity, thereby reducing morbidity
associated with AF, even though patients with ASD closure devices remain
at high risk of developing AF4.
The rising number of patients undergoing percutaneous ASD closure poses
a new challenge in the treatment of coexistent AF. Furthermore, the
reduction of surgical ASD treatment with concurrent cryo- or
radiofrequency ablation (modified Maze procedure) is contributing to
increase the number of patients who would benefit from catheter ablation
after transcatheter ASD closure. Although some studies have shown a high
acute success rate of catheter ablation in this
population5, this treatment is often denied due the
higher perceived risk of performing the transseptal puncture (TSP) after
percutaneous repair of the defect.
Given the lack of definitive data on this topic, in this issue of the
Journal, Garg et al. performed the first meta-analysis evaluating
the safety and the efficacy of catheter ablation for AF in this subset
of high-risk patients with ASD closure devices.