Thoracoscopic pulmonary vein isolation after previous percutaneous atrial septal defect closure

Atrial fibrillation (AF) is the main cause of morbidity among patients over 40 years of age with atrial septal defect (ASD). The closure of ASD in older patients does not decrease the occurrence of AF.^1-3 However, percutaneous ASD closure devices eliminate the possibility of a transseptal approach for future catheter-based procedures such as AF ablation. Epicardial pulmonary vein isolation with a bipolar radiofrequency clamp has been shown to be a safe and effective practice in surgical treatment of AF.^4,5 More recently, this technology has been utilized in a minimally invasive approach through bilateral thoracotomies. We present the case of a thoracoscopic-assisted pulmonary vein isolation on a patient with an atrial septal occlusion device.