LAUSR

Since pulmonary vein isolation for treatment of atrial fibrillation (AF) was introduced in 1990s, several unexpected complications, including atrioesophageal fistula, pulmonary vein stenosis, and stiff left atrial syndrome, have been discovered in those who apparently tolerated the procedure well. Iatrogenic atrial septal defect (iASD) following transseptal puncture is increasingly recognized and may be another nuance surrounding AF ablation unknown. In this issue of the Journal of Interventional Cardiovascular Electrophysiology, Linhart et al. [1] confirmed that iASD is more frequent than our previous estimates. In 102 patients who had undergone cryoballoon ablation with single transseptal puncture, transesophageal echocardiography performed at approximately 3year post-procedure revealed 37% persistent iASD. However, the authors highlighted that an absence of clinical complications or deterioration of echocardiographic parameters was an optimistic message to our community. Is this enough to reassure electrophysiologists and patients that persistent iASD, an unavoidable consequence after transseptal puncture, is a benign defect?