{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:04:43Z","timestamp":1789585483340,"version":"build-2803163510"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Interv Card Electrophysiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent iatrogenic atrial septal defect (iASD) is a known consequence of transseptal puncture (TSP). Large-bore double transseptal access through a single TSP is commonly used for intracardiac echocardiography (ICE)-guided left atrial appendage occlusion (LAAO). This study evaluated the incidence and clinical outcomes of persistent iASD following this approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed LAAO procedures at a single academic center from January 2020 to December 2024. Cases were grouped as: (1) 4D ICE with double transseptal access (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200958), (2) 2D ICE with double transseptal access (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200964), or (3) no left atrial (LA) ICE (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200981). Patients were included if they had follow-up imaging (TEE or cardiac CT). Multivariable logistic regression identified predictors of persistent iASD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 203 patients (age 77.1\u2009\u00b1\u20096.6 years; 59% male), follow-up occurred at 58.0\u2009\u00b1\u200925.2 days. Persistent iASD was detected in 88 patients (43%). ICE-guided cases had a higher incidence of iASD compared with no LA ICE (54.1% vs. 27.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with no difference between 2D and 4D ICE (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.340). On multivariable analysis, both 2D and 4D ICE were independently associated with increased odds of persistent iASD (2D ICE: OR 3.45, 95% CI 1.46\u20138.17; 4D ICE: OR 3.57, 95% CI 1.52\u20138.38). Coronary artery disease was associated with increased odds (OR 2.44, 95% CI 1.12\u20135.28), while hypertension was associated with decreased odds (OR 0.41, 95% CI 0.18\u20130.96). Persistent iASD was not associated with adverse clinical outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Persistent iASD is common following LAAO, occurring in 43% of patients at early follow-up. Left atrial ICE use is independently associated with increased odds of persistent iASD, with similar rates between 2D and 4D ICE techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10840-026-02440-5","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T18:34:29Z","timestamp":1789583669000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent iatrogenic atrial septal defect after single-puncture, double transseptal access for 4D ICE-guided left atrial appendage occlusion: Incidence and clinical outcomes"],"prefix":"10.1007","author":[{"given":"Kasen L","family":"Culler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aamir","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supreet","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Peigh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Korosh","family":"Sharain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya","family":"Pastapur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aravind","family":"Kalluri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anirudh","family":"Nandan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad","family":"Gier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Simon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru B","family":"Chicos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaustubha","family":"Patil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Pfenniger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert C","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rod S","family":"Passman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley P","family":"Knight","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishant","family":"Verma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"issue":"1","key":"2440_CR1","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.tcm.2021.12.001","volume":"33","author":"I Escudero-Mart\u00ednez","year":"2023","unstructured":"Escudero-Mart\u00ednez I, Morales-Caba L, Segura T. 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Rates were similar between groups involving 2D and 4D ICE, suggesting that septal instrumentation rather than imaging modality drives iASD persistence.","order":1,"name":"Ethics","label":"Capsule summary","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Dr. Patil has engaged in speaking, advising or consulting for Abbott Laboratories, Inc. Dr. Lin has engaged in speaking, advising or consulting for Boston Scientific Corporation and Medtronic, Inc. Dr. Passman has engaged in speaking, advising or consulting for Boston Scientific Corporation and Medtronic, Inc. Dr. Knight has engaged in speaking, advising or consulting for Abbott Laboratories, Inc., Boston Scientific Corporation, Biosense Webster, Inc. and Medtronic, Inc.Dr. Kim has engaged in speaking, advising or consulting for Abbott Laboratories, Inc., Boston Scientific Corporation and Medtronic, Inc.Dr. Verma has engaged in speaking, advising or consulting for Abbott Laboratories, Inc., Boston Scientific Corporation and Biosense Webster, Inc.Other authors have no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}