Cryoablation of pulmonary veins in a patient with an atrial septal occluder and atrial fibrillation: A case report

Objective: An atrial septal defect (ASD) is one of the most common congenital heart defects and is associated with an increased risk of atrial arrhythmias.Closure of the ASD reduces this risk; however, when the correction is performed later in life, there is a higher risk of arrhythmias compared to those who undergo the procedure at an earlier age.Cryoballoon ablation of the pulmonary vein orifices is an effective and widely available treatment for symptomatic atrial fibrillation (AF) that is refractory to drugs.Given that this procedure requires access to the left atrium, the presence of an implanted occluder may pose several challenges during surgical intervention.This case study explores the safety of using interventional treatment in patients with an atrial septal occluder for AF.We demonstrate an effective and widely available surgical treatment for symptomatic AF refractory to drugs patient with an atrial septal occluder.Case presentation: We report the case of a 57-year-old woman with an implanted atrial septal occluder who underwent cryoablation for drug-refractory and symptomatic paroxysmal AF.The "Occlutech Figulla Flex II" transseptal occluder was implanted in February 2015 due to an ASD.We used cardiac computed tomography (CT) with contrast to visualize the size and position of the occluder in the atrial septum and determine the puncture area.A single transeptal puncture was performed infero-posterior to the occluder under X-ray control, allowing cryoablation of the pulmonary veins.After the procedure, X-ray and transthoracic echocardiography showed an unchanged device position.After 6 months, the patient had no episodes of AF. Conclusion:In this case, cryoballoon ablation for AF in a patient with an atrial septal occluder was feasible, safe, and effective.The use of cardiac CT with contrast in the preoperative period helps visualize the size and position of the occluder in the atrial septum, determine the size of the native septum, and outline the proposed puncture site.However, further studies are needed to determine the generalizability of these findings.