Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2022; 10(12): 3872-3878
Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3872
Cryoballoon pulmonary vein isolation and left atrial appendage occlusion prior to atrial septal defect closure: A case report
Yu-Cheng Wu, Mei-Xiang Wang, Ge-Cai Chen, Zhong-Bao Ruan, Qing-Qing Zhang
Yu-Cheng Wu, Mei-Xiang Wang, Ge-Cai Chen, Zhong-Bao Ruan, Department of Cardiology, Taizhou People’s Hospital, Taizhou 225300, Jiangsu Province, China
Qing-Qing Zhang, Department of Endocrinology, Taizhou People’s Hospital, Taizhou 225300, Jiangsu Province, China
Author contributions: Wu YC and Wang MX contributed to data collection, original draft preparation and writing; Chen GC and Ruan ZB contributed to operations and monitoring; Zhang QQ contributed to conceptualization, writing, reviewing and editing.
Supported by Taizhou People’s Hospital Scientific Research Start-Up Fund Project, No. QDJJ202113.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qing-Qing Zhang, MD, Doctor, Department of Endocrinology, Taizhou People’s Hospital, No. 366 Taihu Road, Taizhou 225300, Jiangsu Province, China. 2567181759@qq.com
Received: August 17, 2021
Peer-review started: August 17, 2021
First decision: December 17, 2021
Revised: January 6, 2022
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: April 26, 2022
Abstract
BACKGROUND

In patients who suffer from both atrial fibrillation (AF) and atrial septal defect (ASD), cryoballoon pulmonary vein isolation (PVI), sequential left atrial appendage (LAA) occlusion and ASD closure could be a strategy for effective prevention of stroke and right heart failure.

CASE SUMMARY

A 65-year-old man was admitted to our institution due to recurrent episodes of palpitations and shortness of breath for 2 years, which had been worsening over the last 48 h. He had a history of AF, ASD, coronary heart disease with stent implantation and diabetes. Physical and laboratory examinations showed no abnormalities. The score of CHA2DS2VASc was 3, and HAS-BLED was 1. Echocardiography revealed a 25-mm secundum ASD. Pulmonary vein (PV) and LAA anatomy were assessed by cardiac computed tomography. PV mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete PVI. Following the cryoballoon PVI, the patient underwent LAA occlusion under transesophageal echocardiographic monitoring. Lastly, a 34-mm JIYI ASD occlude device was implanted. A follow-up transesophageal echocardiography at 3 mo showed proper position of both devices and neither thrombi nor leakage was found.

CONCLUSION

Sequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.

Keywords: Atrial fibrillation, Atrial septal defect, Cryoballoon, Pulmonary vein isolation, Left atrial appendage occlusion, Case report

Core Tip: Patients who suffer from atrial septal defect (ASD) with atrial fibrillation are prone to right heart dysfunction and embolism. We report the first case treated with a 3-in-1 procedure (cryoballoon pulmonary vein isolation and left atrial appendage occlusion prior to ASD closure), which may not be performed routinely. However, for ASD patients complicated with poorly controlled atrial fibrillation and unable to tolerate long-term oral anticoagulants, this 3-in-1 procedure can be considered.