High rate of persistent iatrogenic atrial septal defect after single transseptal puncture for cryoballoon pulmonary vein isolation

  • Markus Linhart
  • Jessica T. Werner
  • Florian Stöckigt
  • Annika T. Kohlmann
  • Pia C. Lodde
  • Lutz P. T. Linneborn
  • Thomas Beiert
  • Christoph Hammerstingl
  • Roger Borràs
  • Georg Nickenig
  • René P. Andrié
  • Jan W. Schrickel



Congenital atrial septal defect (ASD) is associated with increased morbidity, whereas little is known about the rate of spontaneous closure, associated clinical and echocardiographic parameters, or complications of iatrogenic atrial septal defect (iASD) beyond 1 year of follow-up. Persistent iASD after transseptal puncture for PVI has been described in up to 38% of small cohorts of patients in short-term follow-up after transseptal puncture. We sought to investigate the course of iASD after single transseptal puncture for first pulmonary vein isolation (PVI) with cryoballoon, along with possible risk factors for persistent iASD.


After a first PVI with cryoballoon, 102 patients (64 ± 10 years, 64% male) underwent long-term clinical follow-up and comprehensive transthoracic and transesophageal echocardiographic study.


Prevalence of iASD after PVI was 37% after 2.9 (1.6–4.9) years. No clinical complications or deterioration of echocardiographic parameters were associated with iASD. Lower left atrial appendage flow velocity was associated with higher risk of persistence of iASD (3.5% for every 1 cm/s decrease, p = 0.002).


Despite a high rate of iASD after cryoballoon PVI in long-term follow-up, this was not associated with increased clinical complications. Lower LAA velocity was associated with higher risk of persistent iASD. Repeated routine echocardiographic follow-up may not be necessary in these patients.


Iatrogenic atrial septal defect Transseptal puncture Cryoballoon ablation 


Compliance with ethical standards

The study was approved by the local ethics committee (Ethikkommission an der Medizinischen Fakultät der Rheinischen Friedrich-Wilhelms-Universität Bonn, approval no. 353/13) and was carried out in concordance with the Declaration of Helsinki. All patients gave written informed consent before study inclusion.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Markus Linhart
    • 1
  • Jessica T. Werner
    • 1
  • Florian Stöckigt
    • 1
  • Annika T. Kohlmann
    • 1
  • Pia C. Lodde
    • 1
  • Lutz P. T. Linneborn
    • 1
  • Thomas Beiert
    • 1
  • Christoph Hammerstingl
    • 1
  • Roger Borràs
    • 2
  • Georg Nickenig
    • 1
  • René P. Andrié
    • 1
  • Jan W. Schrickel
    • 1
  1. 1.Medizinische Klinik und Poliklinik IIUniversitätsklinikum BonnBonnGermany
  2. 2.Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain

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