Left Atrial Appendage Exclusion for Atrial Fibrillation

Syed, Faisal F.; DeSimone, Christopher V.; Friedman, Paul A.; Asirvatham, Samuel J.

doi:10.1016/j.hfc.2015.08.022

Cited by 11 publications

(5 citation statements)

References 166 publications

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“…In this category of patients, percutaneous LAA closure has been included in the European Society of Cardiology (ESC) guidelines as a IIb class indication . Several devices are now available and approved for this purpose . In patients with AF who suffer an embolic stroke, there are a number of possible etiologies .…”

Section: Introductionmentioning

confidence: 99%

Left atrial appendage closure: A single center experience and comparison of two contemporary devices

Figini¹,

Mazzone²,

Regazzoli³

et al. 2016

Cathet Cardio Intervent

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Section: Introductionmentioning

confidence: 99%

Left atrial appendage closure: A single center experience and comparison of two contemporary devices

Figini¹,

Mazzone²,

Regazzoli³

et al. 2016

Cathet Cardio Intervent

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“…Lastly, it may be worth investigating patients whose LAA ostium does not shrink in size after ablation, as this cohort may exhibit an "ablation-refractory" phenotype and thus suffer from higher stroke risk despite ablation. For this patient cohort, LAA occlusion should be considered in addition to standard anticoagulation therapy to mitigate stroke risk (37).…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Appendage Remodeling after Atrial Fibrillation Ablation

Zhang

Hajjar

Chao

et al. 2022

Preprint

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Introduction: Larger left atrial appendage (LAA) ostium area and greater left atrial (LA) volume have been associated with an increased risk of ischemic stroke. Catheter ablation (CA) of atrial fibrillation (AF) leads to morphological and functional changes within the LA and LAA, some of which are not well studied. Here, we present findings regarding post-ablation changes of the LAA ostia and correlate them with various LA, LAA and left ventricular (LV) functional and morphological metrics. Methods: This retrospective analysis included patients scheduled to undergo first-time radiofrequency CA for AF. Catheter ablation techniques included PVI with or without additional ablations. Cardiac magnetic resonance imaging (CMR) was used to assess LA, LAA and LV morphology and function, including LAA ostium area, LA/LAA volume and volume index, LA ejection fraction, LA strain, and LV ejection fraction. A Kruskal-Wallis test was used for correlating LAA ostial dimensions with other LA morphological and functional metrics. The t-test or two-sample Wilcoxon test were used to compare LA and LAA morphological parameters. Results: A total of 101 patients with AF were included in this study. The mean age was 60.1 ± 11.1 years, 69% were male, the average BMI was 29.22 ± 5.08. The LAA ostial area reduced significantly from 3.84 ± 1.15 cm before ablation to 3.42 ± 0.96 cm after ablation (p=0.0004). This reduction was asymmetrical, as the minor axis length decreased from 1.92 cm to 1.77 cm without significant changes in the major axis. LVEF increased from a pre-ablation average of 48.26% to a post-ablation average of 53.62% (p=0.015). Correlation of pre-ablation LVEF and LAA ostium area showed a near-significant negative trend (r=-0.21, p=0.083). LAEF correlated negatively with LAA ostial area (r=-0.289, p=0.0057), total LA strain (r=-0.248, p=0.0185), and passive LA strain (r=-0.208, p=0.049). Conclusion: There is a significant asymmetrical reduction of the LAA ostial area after AF ablation that is independent of LVEF changes. Larger LAA ostial area was associated with lower LAEF and LA strain. Remodeling of the LAA after AF ablation may help account for reduced risk of stroke and increased cardiac function.

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“…12 Thromboembolic events occur in 15% to 20% of patients with incomplete closure. 13 Almahameed et al showed that surgical LAA exclusion does not provide optimal protection against thromboembolic events, and the rates are even higher among patients who are not on warfarin prior to hospital discharge. 14 Incomplete closure is characterized by different arbitrary criteria that consider either a reminiscent cavity between mitral valve base and left pulmonary vein (warfarin ridge) or the mere presence of persistent flow in LAA after surgical exclusion.…”

Section: Discussionmentioning

confidence: 99%