Incidence of Left Atrial Appendage Triggers in Patients With Atrial Fibrillation Undergoing Catheter Ablation

Rawahi, Mohamed Al; Liang, Jackson J.; Kapa, Suraj; Lin, Aung Naing; Shirai, Yoshio; Kuo, Ling; Zado, Erica S.; Hyman, Matthew C.; Riley, Michael P.; Nazarian, Saman; García, Fermin C.; Lin, David; Schaller, Robert D.; Arkles, Jeffery; Frankel, David S.; Supple, Gregory E.; Kumareswaran, Ramanan; Callans, David J.; Marchlinski, Francis E.

doi:10.1016/j.jacep.2019.08.012

Cited by 13 publications

(13 citation statements)

References 16 publications

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“…Indeed, our results were consistent with those of a previous study on the Japanese population 21 . Al Rawahi et al 22 sounded an alarm regarding empirical LAA isolation in the initial procedure by demonstrating the low incidence of true LAA triggers (0.3%) and the existence of multiple non‐PV triggers in a large cohort of patients with LAA triggers. Therefore, we excluded LAA as an ablation site due to the following potential risks: LAA perforation, LAA thrombosis after LAA isolation, 23 nonavailability of LAA closing devices in our country, and an indication as the initial procedure.…”

Section: Discussionsupporting

confidence: 91%

Clinical impact of eliminating nonpulmonary vein triggers of atrial fibrillation and nonpulmonary vein premature atrial contractions at initial ablation for persistent atrial fibrillation

Fukunaga

Nagashima

Korai

et al. 2020

Cardiovasc electrophysiol

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Background The role of nonpulmonary vein (PV) triggers ablation in persistent atrial fibrillation (PEAF) was suggested but it is still under debate. Objectives We aimed to assess the effectiveness of non‐PV trigger‐targeted ablation for patients with PEAF. Methods Consecutive patients with PEAF undergoing catheter ablation (CA) between January 2015 and April 2017 were enrolled. Isoproterenol plus adenosine challenge was performed to provoke non‐PV triggers. Non‐PV triggers were defined as the trigger beats inducing AF (non‐PV AF triggers) and/or frequent premature contractions (non‐PV PACs) from other than PVs. Three groups were defined: Group 1 (n = 186) without non‐PV triggers; Group 2 (n = 65) with non‐PV triggers that could be completely eliminated with CA; Group 3 (n = 49) with non‐PV triggers still inducible after CA. The primary endpoint was freedom from any atrial tachyarrhythmia (ATa) recurrence. Results A total of 300 patients (230 males, age 64 ± 10) were enrolled. The mean follow‐up period was 27 ± 10 months. Freedom from ATa recurrence at 1 and 2 years were significantly lower in Group 3 compared to the other two groups (Group 1; 74.7%, 67.2% vs. Group 2; 75.8%, 68.3% vs. Group 3: 52.1%, 38.6%, p = .0005), irrespective of the type of non‐PV triggers (non‐PV AF triggers vs. non‐PV PACs). On multivariate analysis, unsuccessful elimination of non‐PV triggers was an independent predictor for ATa recurrence (hazard ratio = 1.80, 95% confidence interval = 1.07–2.95, p = .026). Conclusion Successful non‐PV triggers elimination can improve the ATa recurrence rate in PEAF ablation. ATa recurrence rate is higher, if non‐PV AF triggers or even non‐PV PACs remain in patients with PEAF.

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Section: Discussionsupporting

confidence: 91%

Clinical impact of eliminating nonpulmonary vein triggers of atrial fibrillation and nonpulmonary vein premature atrial contractions at initial ablation for persistent atrial fibrillation

Fukunaga

Nagashima

Korai

et al. 2020

Cardiovasc electrophysiol

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“…Atrial electrical foci location responsible for AF is a matter of debate as no clear consensus for their detection is available at the moment. LAA, even if rarely associated with AF trigger [18], have been identified in other previous studies, as a potential important origin for AF maintenance during persistent AF. Di Biase et al [10] first, reported the potential arrythmogenic role of the LAA during AF.…”

Section: Af Evolution Disease and Laa Arrhythmogenicitymentioning

confidence: 55%

Atrial fibrillation evolution and rhythm control strategy following left appendage closure: new insights from the prospective FLAAC registry

Lellouche

Arrouasse

Ternacle

et al. 2021

BMC Cardiovasc Disord

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Background Percutaneous left atrial appendage (LAA) closure is an alternative to oral anticoagulation (OAC) for atrial fibrillation (AF) patients with high thromboembolism risk, particularly with contraindications to OAC. The LAA itself could possess proarrhythmogenic properties. As patients undergoing LAA closure could be candidates for cardioversion or ablation, we aimed to evaluate AF disease progression following LAA closure and the outcome of patients undergoing a rhythm control strategy after the procedure. Methods The prospective multicenter French Nationwide Observational LAA Closure Registry (FLAAC) comprises 33 French interventional cardiology departments. Patients were included if they fulfilled the following criteria: history of non-valvular AF, successful LAA closure and long-term ECG follow-up. Results A total of 331 patients with successful LAA closure were enrolled in the study. Patients mean age was 75.4 ± 0.5 years. The study population was characterized by a high thromboembolic risk (CHA2DS2-VASc score: 4.5 ± 0.1) and frequent comorbidities. The median follow-up was 11.9 months. One hundred and nineteen (36.0%) patients were in sinus rhythm (SR) at baseline. Among SR patients, documented AF was observed in 16 (13.4%) patients whereas 15 (7.1%) patients in AF at baseline restored SR, at the end of follow up. Finally, only 13 patients (4%) underwent procedures to restore SR without complications during the follow-up. Conclusions The vast majority of patients undergoing LAA closure have the same AF status at baseline and one year after the index procedure. During the follow-up, a very small proportion (4%) of our population underwent procedures to restore SR without complications whatever the post-procedural antithrombotic strategy was.

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“…11 The LAA can initiate AF and has been associated with 75%-90% of thrombotic events in non-valvular AF. 12,13 As an important part of the Mei mini-maze, the LAA can be excluded using a surgical stapler or clipped with an AtriClip. 14,15 Both methods improve the success rate of AF ablation and help prevent stroke.…”

Section: Discussionmentioning

confidence: 99%

The Mei mini-maze procedure

Jiang

Tang

et al. 2020

Asian Cardiovasc Thorac Ann

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Atrial fibrillation is a common clinical arrhythmia with high morbidity and a risk of stroke. The Cox-maze IV procedure that uses radiofrequency energy for ablation is established as an effective way to eliminate atrial fibrillation. Compared to the Cox-maze IV procedure, the video-assisted Wolf mini-maze procedure is associated with reduced surgical trauma, but still requires bilateral thoracotomies, and the ablation line connecting the right and left pulmonary vein isolations cannot be created with a bipolar ablation clamp. We have developed a novel video-assisted mini-maze technique that uses a unilateral (left chest) thoracoscopic approach (the Mei mini-maze procedure).

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Incidence of Left Atrial Appendage Triggers in Patients With Atrial Fibrillation Undergoing Catheter Ablation

Cited by 13 publications

References 16 publications

Clinical impact of eliminating nonpulmonary vein triggers of atrial fibrillation and nonpulmonary vein premature atrial contractions at initial ablation for persistent atrial fibrillation

Clinical impact of eliminating nonpulmonary vein triggers of atrial fibrillation and nonpulmonary vein premature atrial contractions at initial ablation for persistent atrial fibrillation

Atrial fibrillation evolution and rhythm control strategy following left appendage closure: new insights from the prospective FLAAC registry

The Mei mini-maze procedure

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