Transcatheter Closure of Atrial Septal Defect in Elderly Patients With Permanent Atrial Fibrillation Manabu Taniguchi, 1 * MD, Teiji Akagi, 1 MD, Shinichi Ohtsuki, 2 MD, Yoshio Okamoto, 2 MD, Yasuharu Tanabe, 3 RDCS, Nobuhisa Watanabe, 3 RDCS, Koji Nakagawa, 4 MD, Norihisa Toh, 4 MD, Kengo Kusano, 4 MD, and Shunji Sano, 1 MD Objectives: The aim of this study is to evaluate the feasibility and efficacy of device closure of atrial septal defect (ASD) in elderly patients with permanent atrial fibrilla- tion. Background: Little is known about the feasibility of device closure of ASD in those patients. Methods: Nine consecutive patients (mean age 68.1 years) with perma- nent atrial fibrillation (>1 year persistent) underwent catheter closure using the Amplat- zer septal occluder. Transthoracic echocardiography and plasma B-type natriuretic peptide (BNP) level were assessed before and at 24 hours; and 1, 3, and >6 months af- ter the closure. Before the procedure, appropriate dose of warfarin was used in all, diuretics was used in 8/9. Same amount of medications were continued after the procedure. Results: ASD could be closed in all (mean device size 27.3 mm) without hemodynamic and thromboembolic complications. New York Heart Association (NYHA) functional classification was significantly improved in all patients after device closure. No hemodynamic and thromboembolic complications were observed during the fol- low-up period (mean 10.6 months). Although permanent atrial fibrillation did not change in all after the procedure, resting heart rate decreased from 76.2 6 16.0 to 68.3 6 13.2 beats/min (P 5 0.015). There was statistically significant improvement in right ventricular/left ventricular diameter ratio (1.08 6 0.16 to 0.73 6 0.10, P 5 0.008) and plasma BNP level (183.7 6 90.5 to 94.6 6 47.4 pg/mL, P 5 0.008) after >6 months device closure. Conclusions: Even in the patients complicated with permanent fibrilla- tion, transcatheter closure of ASD can contribute to symptomatic improvement as well as cardiac geometric remodeling. ' 2009 Wiley-Liss, Inc. Key words: cardiac remodeling; transcatheter intervention; congenital heart defect; B-type natriuretic peptide INTRODUCTION Atrial septal defect (ASD) is one of the most com- mon congenital heart diseases in adults. Many patients with isolated ASD are diagnosed in adulthood because most children and young adult patients with ASD are free from overt symptoms. Although patients with uncorrected ASD often survive to an advanced age [1], clinical symptoms, including palpitations, exertional dyspnea, and fatigue, are frequently observed in their lives. Previous studies have shown benefits of surgical closure of ASD in older age in comparison with medi- cal treatment [2–4]. In recent years, transcatheter clo- sure of ASD has been established as an effective and secure treatment, and the procedure has become an alternative to a surgical approach for treatment of secundum ASD [5,6]. It is well known that cardiac geometric changes or hemodynamic improvement Conflict of interest: There is no conflict of interest exists. 1 Division of Cardiac Care Unit, Okayama University Hospital, Okayama, Japan 2 Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan 3 Division of Central Clinical Laboratory, Okayama University Hospital, Okayama, Japan 4 Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan *Correspondence to: Manabu Taniguchi, MD, 2-5-1 Shikata-Cho, Okayama 700-8558, Japan. E-mail: tmnb@md.okayama-u.ac.jp Received 16 July 2008; Revision accepted 15 October 2008 DOI 10.1002/ccd.21870 Published online 9 January 2009 in Wiley InterScience (www. inter- science.wiley.com). ' 2009 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 73:682–686 (2009)