Totally thoracoscopic ablation is a safe and feasible treatment for atrial tachyarrhythmia after transcatheter atrial septal defect closure, with 7 of 9 patients maintaining sinus rhythm.
Observational (n=9)
No
Does totally thoracoscopic ablation safely and feasibly treat atrial tachyarrhythmia in patients who have previously undergone transcatheter atrial septal defect closure?
Totally thoracoscopic ablation is a feasible and safe alternative for treating atrial fibrillation in patients with prior transcatheter ASD closure, bypassing the technical challenges of trans-septal puncture.
Background and Objectives: Atrial septal defect (ASD) often accompanies atrial fibrillation (AF). AF is usually treated with radiofrequency catheter ablation (RFCA) before transcatheter ASD closure. However, there is still no established consensus on the treatment of AF after transcatheter ASD closure, as the deployed occluder makes access to the left atrium during RFCA more challenging. We report 9 cases of totally thoracoscopic ablation (TTA) for atrial tachyarrhythmia following transcatheter ASD closure. Methods: From 2012 to 2021, 9 patients underwent TTA for atrial tachyarrhythmia that developed or recurred after transcatheter ASD closure. TTA, a type of video-assisted thoracoscopic surgery, was performed to achieve transmural ablation of the atria. Results: Seven patients had been diagnosed with atrial tachyarrhythmia before transcatheter ASD closures; 3 had undergone RFCA, and 4 had received direct-current cardioversion. All 9 patients were in sinus rhythm at the time of transcatheter ASD closure. During a mean follow-up of 44.9 ± 39.4 months after closure, atrial tachyarrhythmia developed or recurred in all patients. After TTA, every patient was discharged without atrial tachyarrhythmia. The mean follow-up duration after TTA was 58.7 ± 41.1 months. Atrial arrhythmia recurred in 2 patients; in one, sinus rhythm was restored after post-TTA RFCA. A cerebral infarction occurred in one patient despite maintaining sinus rhythm after TTA. N-terminal pro brain natriuretic peptide levels significantly decreased after TTA (P = 0.021). Int J Arrhythm. 2026 Feb 3;27:e2 https://doi.org/10.18501/ija.2026.27.e2 eISSN 2466-1171 Safety and feasibility of totally thoracoscopic ablation for atrial fibrillation after transcatheter atrial septal defect closure Research Received: Jul 8, 2025 Accepted: Dec 30, 2025 Published online: Feb 3, 2026 *Correspondence: Min Suk Choi Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Republic of Korea. Email: dgcms@naver.com © 2026 Korean Heart Rhythm Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ORCID iDs Dong Seop Jeong https://orcid.org/0000-0002-6947-8403 Kyungsub Song https://orcid.org/0000-0002-6556-2261 Min Suk Choi https://orcid.org/0000-0002-5482-1272 Abbreviations AAD, antiarrhythmic drug; AF, atrial fibrillation; AFL, atrial flutter; ASD, atrial septal defect; CI, confidence interval; DC, direct-current; LA, left atrial; LAVI, left atrial volume index; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro brain natriuretic peptide; OAC, oral anticoagulant; PASP, pulmonary atrial systolic pressure; RFCA, radiofrequency catheter ablation; TTA, totally thoracoscopic ablation. Dong Seop Jeong 1, Kyungsub Song 2, Min Suk Choi 3* 1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 2Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Republic of Korea 3Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Republic of Korea https://e-arrhythmia.org Availability of data and materials The underlying data of this study can be opened to public. Funding Not applicable. Competing interests The authors have no potential conflicts of interest to disclose. Ethics approval and consent to participate The present study protocol was reviewed and approved by the Institution Review Board of Samsung Medical Center (approval No. 2022- 01-006-001). Consent for publication Informed consent was waived. Author contributions Conceptualization: Jeong DS, Choi MS; Data curation: Jeong DS; Formal analysis: Song K; Investigation: Jeong DS; Methodology: Jeong DS; Project administration: Jeong DS, Choi MS; Resources: Song K; Software: Song K; Supervision: Jeong DS, Choi MS; Validation: Jeong DS, Song K, Choi MS; Writing - original draft: Jeong DS, Song K; Writing - review Catheter ablation; Heart septal defects, atrial; Left atrial appendage closure; Thoracic surgery, video-assisted
Jeong et al. (Thu,) conducted a observational in Atrial tachyarrhythmia after transcatheter atrial septal defect closure (n=9). Totally thoracoscopic ablation (TTA) was evaluated on Recurrence of atrial tachyarrhythmia. Totally thoracoscopic ablation is a safe and feasible treatment for atrial tachyarrhythmia after transcatheter atrial septal defect closure, with 7 of 9 patients maintaining sinus rhythm.