Is combined use of radiofrequency ablation and balloon dilation the future of interatrial communications?

ABSTRACT

Introduction

Personalized and stable interatrial communication is an important palliative therapy for patients with heart failure. However, this remains a technically challenging task.

Areas covered

In the past decades, substantial advancements in atrial septostomy for the creation of controllable and durable interatrial communication have been made, and numerous novel devices and techniques are in various stages of development. In this review, we discuss the evolving indications for atrial septostomy, current approaches with or without device implantation, and indicators for optimal interatrial communication. The combined use of radiofrequency ablation and balloon dilation (CURB) is an individualized management approach based on underlying hemodynamics, which demonstrates unique advantages in creating a sufficient interatrial communication with satisfactory stability. The advantages and disadvantages of this implant-free procedure are analyzed and its clinical prospects are assessed.

Expert opinion

With ready availability, high safety, and efficacy, CURB is a promising procedure for creating personalized and stable interatrial communication without device implantation. Further research is required to simplify the procedure, screen optimal reference parameters for personalized therapy, and evaluate the long-term outcome in a large population of patients.

KEYWORDS:

• Atrial septostomy
• balloon dilation
• personalized management
• radiofrequency ablation
• stability

Article highlights

• Challenges remain in the creation of adequate and sustainable interatrial communication that has beneficial effects on circulatory decompression.

• The combined use of radiofrequency ablation and balloon dilation (CURB) according to hemodynamic parameters has the potential to establish personalized and stable interatrial communication without device implantation.

• With ready availability and satisfactory efficacy, CURB is a promising implant-free procedure for personalized atrial septostomy.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by grant 61975240 from the National Natural Science Foundation of China (NSFC) and grant 2020-I2M-C&T-B-065 from the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences.