Tạp chí Tim mạch học Việt Nam

Article detail

Article detail description

Home
CA LÂM SÀNG Issue: Số 121 - 2026 TIM MẠCH CAN THIỆP

Radiofrequency Ablation of Atrial Fibrillation Combined with Transcatheter Closure of Secundum Atrial Septal Defect in Single Session: A Case Report

Phan Đình Nghĩa: Viện Tim mạch, Bệnh viện 19-8, Bộ Công an; Phạm Mạnh Hùng: Trường Đại học Y Hà Nội; Lê Văn Đạt: Viện Tim mạch, Bệnh viện 19-8, Bộ Công an; Bùi Thành Đạt: Viện Tim mạch, Bệnh viện 19-8, Bộ Công an; Lê Mạnh Tăng: Viện Tim mạch, Bệnh viện 19-8, Bộ Công an; Lê Mạnh: Viện Tim mạch, Bệnh viện 19-8, Bộ Công an; Nguyễn Thị Thu Thủy: Viện Tim mạch, Bệnh viện 19-8, Bộ Công an;
Published: May 30, 2026
Views: 129
DOI 10.58354/jvc.121.2026.1321

Abstract

We report a case of a 63-year-old female patient diagnosed with a large secundum atrial septal defect (ASD) (22×29 mm) accompanied by symptomatic paroxysmal atrial fibrillation (AF) (EHRA class III), moderate-to-severe pulmonary arterial hypertension (estimated pulmonary artery systolic pressure ~50 mmHg), and left atrial enlargement (50 mm). The ASD anatomy was complex, featuring a deficient inferior vena cava (IVC) rim (firm portion 6 mm, floppy portion 24.5 mm) and an absent aortic rim. The patient underwent radiofrequency (RF) catheter ablation with complete pulmonary vein isolation (PVI) to restore sinus rhythm, followed immediately by transcatheter ASD closure in a single combined session. Balloon sizing revealed an ASD diameter of 32 mm with an indistinct stop-flow balloon waist; a 38-mm Cocoon septal occluder was selected and successfully deployed after transesophageal echocardiography (TEE) confirmed satisfactory disc engagement across all available rims without mitral valve impingement. This report highlights the feasibility and technical challenges of a combined single-session interventional approach in this particularly complex patient subset.

Keywords
secundum atrial septal defect atrial fibrillation radiofrequency ablation pulmonary vein isolation transcatheter closure deficient IVC rim single-session intervention

References

1.
Geva T, Martins JD, Wald RM. Atrial septal defects. Lancet. 2014;383(9932):1921-1932. doi:10.1016/S0140-6736(13)62145-5.
DOI: doi.org/10.1016/s0140-6736(13)62145-5
2.
Berger F, Vogel M, Kramer A, et al. Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after catheter closure or surgical repair. Am J Cardiol. 1999;83(2):231-233. doi:10.1016/S0002-9149(98)00838-0.
DOI: doi.org/10.1016/s0140-6736(13)62145-5
3.
Lam YY, Li X, Yip GWK, et al. Long-term improvements in atrial remodeling and pulmonary arterial pressure after percutaneous closure of atrial septal defect in adults. Am J Cardiol. 2004;93(4):506-509. doi:10.1016/j.amjcard.2003.10.043.
DOI: doi.org/10.1016/s0003-4975(99)00478-6
4.
Yalonetsky S, Lorber A. Comparative changes in pulmonary artery pressure and vascular resistance after transcatheter atrial septal defect closure. Congenit Heart Dis. 2009;4(1):28-31. doi:10.1111/j.1747-0803.2008.00253.x.
DOI: doi.org/10.1111/j.1747-0803.2008.00253.x
5.
Spies C, Khandelwal A, Timmermanns I, et al. Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults. Am J Cardiol. 2008;102(7):902-906. doi:10.1016/j.amjcard.2008.05.043.
DOI: doi.org/10.1016/j.amjcard.2008.05.043
6.
Chen SA, Tai CT. Catheter ablation of atrial fibrillation originating from the non-pulmonary vein foci. J Cardiovasc Electrophysiol. 2005;16(2):229-232. doi:10.1046/j.1540-8167.2005.50038.x.
DOI: doi.org/10.1016/j.amjcard.2003.10.043
7.
Masura J, Gavora P, Podnar T. Long-term outcome of transcatheter secundum-type atrial septal defect closure using Amplatzer septal occluders. J Am Coll Cardiol. 2005;45(4):505-507. doi:10.1016/j.jacc.2004.10.064.
DOI: doi.org/10.1111/j.1747-0803.2008.00245.x
8.
Wylie JV Jr, Vaidya VR, Kapa S, et al. Relationship between left atrial size and outcomes of catheter ablation for atrial fibrillation. J Interv Card Electrophysiol. 2015;42(1):37-44. doi:10.1007/s10840-014-9958-8.
DOI: doi.org/10.1007/s10840-014-9958-8
9.
Santangeli P, Di Biase L, Burkhardt JD, et al. Catheter ablation of atrial fibrillation in patients with atrial septal defect: clinical insights from a multicenter study. Circ Arrhythm Electrophysiol. 2011;4(4):480-486. doi:10.1161/CIRCEP.111.962514.
DOI: doi.org/10.1016/j.amjcard.2008.05.045
10.
Zhao Y, Zhao Q, Yao Y, et al. Combined catheter ablation of atrial fibrillation and interventional closure of atrial septal defect: a single-center experience. Int J Cardiol. 2017;242:226-230. doi:10.1016/j.ijcard.2017.03.132.
DOI: doi.org/10.1016/j.amjcard.2008.05.043
11.
Aly MF, Tang M, Tin AS, et al. Pulmonary vein isolation and atrial septal defect closure in adults: when is the right time? Heart Rhythm. 2009;6(1):76-82. doi:10.1016/j.hrthm.2008.09.016.
DOI: doi.org/10.1046/j.1540-8167.2005.40665.x
12.
Oral H, Pappone C, Chugh A, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med. 2006;354(9):934-941. doi:10.1056/NEJMoa050955.
DOI: doi.org/10.1046/j.1540-8167.2005.50038.x
13.
Vogel M, Berger F, Kramer A, et al. Incidence of secondary pulmonary hypertension in adults with atrial septal or sinus venosus defects. Heart. 1999;82(1):30-33. doi:10.1136/hrt.82.1.30.
DOI: doi.org/10.1016/j.accreview.2005.05.061
14.
Rao PS. Percutaneous closure of atrial septal defects with deficient or absent rims. J Interv Cardiol. 2009;22(4):386-393. doi:10.1111/j.1540-8183.2009.00481.x.
DOI: doi.org/10.1016/j.jacc.2004.10.064
15.
Du ZD, Koenig P, Hijazi ZM, et al. Comparison of transcatheter closure of secundum atrial septal defect using the Amplatzer septal occluder associated with deficient versus sufficient rims. Am J Cardiol. 2002;90(8):865-869. doi:10.1016/S0002-9149(02)02658-1.
DOI: doi.org/10.1016/s0002-9149(02)02658-1
16.
Cao QL, Du ZD, Koenig P, et al. Speed of normalization of right ventricular volume overload after transcatheter closure of atrial septal defect in children and adults. Am J Cardiol. 2001;88(12):1450-1453. doi:10.1016/S0002-9149(01)02173-5.
DOI: doi.org/10.1016/s0002-9149(01)02173-5
17.
Crawford GB, Brindis RG, Krucoff MW, et al. Percutaneous atrial septal occluder devices and cardiac erosion: a review of the literature. Catheter Cardiovasc Interv. 2012;80(2):157-167. doi:10.1002/ccd.23346.
DOI: doi.org/10.1002/ccd.23346
18.
Butera G, De Rosa G, Chessa M, et al. Transcatheter closure of atrial septal defect in young children: results and follow-up. J Am Coll Cardiol. 2003;42(2):241-245. doi:10.1016/S0735-1097(03)00584-6.
DOI: doi.org/10.1016/s0735-1097(03)00584-6
19.
Amin Z, Hijazi ZM, Bass JL, et al. Erosion of Amplatzer septal occluder device after closure of secundum atrial septal defects: review of registry of complications and recommendations to minimize future risk. Catheter Cardiovasc Interv. 2004;63(4):496-502. doi:10.1002/ccd.20211.
DOI: doi.org/10.1002/ccd.20211
20.
Rillig A, Meyborg M, Hansel J, et al. Catheter ablation of atrial fibrillation in patients with atrial septal defects closed with interventional techniques. J Interv Card Electrophysiol. 2012;33(3):265-270. doi:10.1007/s10840-011-9632-1.
DOI: doi.org/10.1016/j.ijcard.2017.03.132
Radiofrequency Ablation of Atrial Fibrillation Combined with Transcatheter Closure of Secundum Atrial Septal Defect in Single Session: A Case Report

Files

PDF
Article Views129
Document Views8
Downloads5
Section CA LÂM SÀNG
Issue Số 121 - 2026
Category TIM MẠCH CAN THIỆP
Pages 138-146
Copyright Holder 2026 Tạp chí Tim mạch học Việt Nam

Related articles section label

Related articles

Related articles category hint

More articles

The Role of Combined Plaque Modification Strategies in Percutaneous Coronary Intervention for Severe Coronary Calcification: A Case-Based Discussion

Background: Severe coronary artery calcification (SCAC) remains one of the most challenging lesion subsets in percutaneous coronary intervention (PCI), affecting approximately 20–30% of patients undergoing coronary revas...

Chi tiết bài báo
PDF
DOI: 10.58354/jvc.121.2026.1322
115
Phạm Mạnh Hùng; Dương Hồng Niên; Bùi Thành Đạt; Phạm Nhật Minh; Phan Đình Nghĩa; Lê Văn Đạt