Left Atrial Appendage Isolation in Patients Not Responding to Pulmonary Vein Isolation

Heeger, Christian‐Hendrik; Rillig, Andreas; Geisler, D; Wohlmuth, Peter; Fink, Thomas; Mathew, Shibu; Tilz, Roland Richard; Reißmann, Bruno; Lemeš, Christine; Maurer, Tilman; Santoro, Francesco; Inaba, Osamu; Sohns, Christian; Huang, Yinhao; Alessandrini, Hannes; Dotz, Inge; Schlüter, Michael; Metzner, Andreas; Kuck, Karl‐Heinz; Ouyang, Feifan

doi:10.1161/circulationaha.118.037451

Cited by 56 publications

(45 citation statements)

References 5 publications

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“…This same result was also reported by other investigators [72]. In addition to a more distinct ablation along the base of the LAA aiming at isolation [71,72], some operators achieve LAA isolation by wide-area LA ablation with LA lines in addition to PVI [73]. Nevertheless, it should be kept in mind that isolation of the LAA in these cases has been shown to be associated with a significantly increased risk for LAA thrombus formation and thromboembolic events [74,75].…”

Section: Catheter Ablation Of Af Beyond Pvisupporting

confidence: 79%

Catheter Ablation of Atrial Fibrillation: State of the Art and Future Perspectives

Rottner

Bellmann²,

Lin

et al. 2020

Cardiol Ther

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Purpose of Review: Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with high rates of morbidity and mortality. Maintenance of stable sinus rhythm (SR) is the intended treatment target in symptomatic patients, and catheter ablation aimed at isolating the pulmonary veins provides the most effective treatment option, supported by encouraging clinical outcome data. A variety of energy sources and devices have been developed and evaluated. In this review, we summarize the current state of the art of catheter ablation of AF and describe future perspectives. Recent Findings: Catheter ablation is a wellestablished treatment option for patients with Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11357912.

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Section: Catheter Ablation Of Af Beyond Pvisupporting

confidence: 79%

Catheter Ablation of Atrial Fibrillation: State of the Art and Future Perspectives

Rottner

Bellmann²,

Lin

et al. 2020

Cardiol Ther

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“…In line with these observations, in six of nine patients, LAAT was found in a previously electrically isolated LAA, even if five of six patients were in stable SR. LAA electrical isolation seems to be related to an increased thrombogenicity, irrespective of LAA emptying velocity . The optimal anticoagulation strategy is still under debate because metanalytic data failed to demonstrate this association, but new evidence seems to point toward higher thromboembolic risk in these selected patients . The present series shows once again how a mechanical noncontracting LAA can be prone to LAAT formation: LAA occlusion with the exclusion of a noncontracting appendage may be the best option to reduce a pathogenically increased risk of stroke.…”

Section: Discussionmentioning

confidence: 67%

“…13 The optimal anticoagulation strategy is still under debate because metanalytic data failed to demonstrate this association, 15,16 but new evidence seems to point toward higher thromboembolic risk in these selected patients. 17,18 The present series shows once again how a mechanical noncontracting LAA can be prone to LAAT formation: LAA occlusion with the exclusion of a noncontracting appendage may be the best option to reduce a pathogenically increased risk of stroke. Finally, it can be speculated that a previous presence of a LAAT may lead to an increased risk of device-related thrombi: to be noticed, none of there were recorded in our TEE follow up.…”

Section: Laat Patients' Characteristicsmentioning

confidence: 74%

Percutaneous left atrial appendage closure in the presence of thrombus: A feasibility report

Bordignon

Bologna

Chen

et al. 2019

Cardiovasc electrophysiol

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Background Patients with a left atrial appendage thrombus (LAAT) despite oral anticoagulation (OAC) are at high risk of thromboembolism (TE) and a relevant proportion of LAAT do not resolve under continued OAC. Left atrial appendage closure (LAAC) in the presence of LAAT was anecdotally described as a therapeutic option to prevent TE in the patients. Objective To describe the feasibility of LAAC despite LAAT in consecutive patients. Methods We searched the LAAC database of our center to identify patients in whom a LAAC was performed despite evidence of a thrombus in the LAA. All procedures were performed under transesophageal echocardiography guidance, no angiographies were performed to avoid LAAT dislocation. An Amulet Occluder device was preferred to allow proximal implantation and sealing of the LAA. Results Nine patients were identified. The mean age was 68.1 ± 10.7 years, four were female, mean CHADSVASC and HASBLED were 3.6 ± 1.7 and 3.0 ± 1.0. Eight of nine patients were on OAC, one patient was under lone aspirin therapy because of bleeding. The mean distance between the LAAT and the estimated landing zone was 18 ± 6 mm, the minimal distance was 11 mm. The mean landing zone was 21 ± 3 mm, devices with a mean size of 25 ± 4 mm were chosen for implantation. All implantation succeeded, only two patients required an intraprocedural replacement. No procedural complication nor short term thromboembolic complication during a follow up of 138 ± 149 days were recorded. Conclusion In the presented series a percutaneous LAAC despite a LAAT resulted to be feasible and safe.

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“…This fact suggests that the LAA is responsible for arrhythmia recurrence in a subset of patients. However, LAA isolation may negatively affect LAA mechanical function, and thereby potentially increase the risk of thromboembolism . Thus, it is desirable to identify patients who are most likely to respond to LAA isolation.…”

Section: Introductionmentioning

confidence: 99%

Endocardial contact mapping of the left atrial appendage in persistent atrial fibrillation

Takahashi

Akiyoshi

Sekigawa

et al. 2019

Cardiovasc electrophysiol

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Introduction: Isolation of the left atrial appendage (LAA) is often performed in persistent atrial fibrillation (AF). Propagation patterns in the LAA during AF remain to be elucidated.We sought to characterize propagation patterns in the LAA during AF in persistent AF.Methods: Persistent AF patients undergoing catheter ablation were studied.Pulmonary vein isolation (PVI) was performed during continuous AF. If AF was not terminated by PVI, bi-atrial mapping was performed using a multi-electrode catheter during AF. Maps were collected at each site for 30 seconds and analyzed offline with a novel software, CARTOFINDER. This software made automatic determinations of whether activation was focal or rotational. The left atrium (LA) was divided into five regions, of which the LAA was one, and the right atrium (RA) into three.Results: Eighty patients were studied (62 ± 10 years, 65 males). On average, 9.6 ± 2.2 and 4.1 ± 1.2 maps were created in the LA and RA, respectively. The LAA was mapped in 70 patients, resulting in 85 maps. In the LAA, activation was identified as focal more often than rotational (64 [91%] vs 10 [14%] patients, P < .001), seven patients displayed both. The number of focal activation events was greatest in the LAA (28.5 events/30 seconds [interquartile range, 15-54]) of the eight atrial regions. During focal activation, sites designated as earliest activation frequently covered a wide area, rather than being localized to a discrete site (5.4 ± 3.1 electrodes). Conclusions:The results of this study suggest that focal activation is a major mechanism underlying the arrhythmogenicity of the LAA in persistent AF. K E Y W O R D S atrial fibrillation, left atrial appendage, mapping

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Left Atrial Appendage Isolation in Patients Not Responding to Pulmonary Vein Isolation

Cited by 56 publications

References 5 publications

Catheter Ablation of Atrial Fibrillation: State of the Art and Future Perspectives

Catheter Ablation of Atrial Fibrillation: State of the Art and Future Perspectives

Percutaneous left atrial appendage closure in the presence of thrombus: A feasibility report

Endocardial contact mapping of the left atrial appendage in persistent atrial fibrillation

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