Left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation: one-year clinical outcome after cryoballoon-based ablation

Yorgun, Hikmet; Canpolat, Uğur; Koçyiğit, Duygu; Çöteli, Cem; Evranos, Banu; Aytemir, Kudret

doi:10.1093/europace/eux005

Cited by 102 publications

(95 citation statements)

References 17 publications

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“…Our analysis demonstrates a robust benefit as shown in the influence analysis despite relatively small sample sizes. All studies demonstrated more than 65% reduction in the odds of AF recurrence 27, 32, 33, 34, 35…”

Section: Discussionmentioning

confidence: 94%

“…We reviewed 19 citations for full‐text articles; five full‐text articles were included in final analysis 27, 32, 33, 34, 35. Of the five included studies, one was a randomized clinical trials,32 three were prospective cohort studies,27, 33, 34 and one was a retrospective cohort study 35…”

Section: Resultsmentioning

confidence: 99%

“…Four studies compared LAA isolation in addition to PVI compared to PVI alone 27, 32, 34, 35. Nonpulmonary triggers, such as the posterior wall of the left atrium, the coronary sinus and the superior vena cava, were similarly ablated in both groups at the operators’ discretion.…”

Section: Resultsmentioning

confidence: 99%

“…Study and baseline patient characteristics in the individual studies are shown in Tables 1 and 2, respectively. Four studies included patients with predominantly LSPAF,27, 32, 33, 34 one study was conducted in predominantly persistent AF 35. The duration of follow‐up ranged from 12 to 15 months.…”

Section: Resultsmentioning

confidence: 99%

“…The average duration of AF pre‐intervention ranged from 25 to 90 months in PVI + LAAI group and 24‐83 months in PVI‐alone group. Of the four studies that used LAA isolation, three were performed using radiofrequency ablation27, 32, 34 and one using cryoballoon ablation 35. In the study by Panniker et al,34 LAA isolation was followed by occlusion of the LAA using the WATCHMAN device.…”

Section: Resultsmentioning

confidence: 99%

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Left atrial appendage isolation in atrial fibrillation catheter ablation: A meta‐analysis

AlTurki

Huynh

Dawas

et al. 2018

Journal of Arrhythmia

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A significant proportion of patients’ experience recurrence of atrial fibrillation (AF) despite pulmonary venous isolation (PVI), especially those with persistent AF. Isolation of the left atrial appendage (LAA) may reduce AF recurrence. The aim of this study was to assess the efficacy of LAA isolation in addition to PVI compared with PVI alone. We conducted a comprehensive search of electronic databases, up to April 21st, 2017, for all studies comparing the effect LAA electrical isolation or ligation in addition to PVI, as opposed to PVI alone, on the recurrence of atrial fibrillation after catheter ablation. We used random‐effects meta‐analysis models to summarize the studies. One RCT and four observational studies enrolling 781 patients were retained. Four studies assessed the added effect of LAA catheter ablation, and one study evaluated the effect of LAA ligation with the aim of LAA electrical isolation. Four studies exclusively enrolled patients with persistent atrial fibrillation and one study predominantly enrolled patients with persistent atrial fibrillation. Follow‐up ranged from 12 to 15 months. The addition of LAA isolation to PVI reduced AF recurrence compared with the latter alone (odds ratio (OR) = 0.19; 95% confidence intervals (CI) = 0.10‐0.37; P < 0.00001). Left atrial appendage isolation was also associated with a reduction in AF recurrence after repeat ablation (OR = 0.40; CI = 0.25‐0.65; P = 0.0003). The addition of LAA isolation to PVI was associated with a decrease in AF recurrence in patients with persistent AF. Further studies are needed to assess the effect on long‐term risk of stroke.

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Section: Discussionmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Left atrial appendage isolation in atrial fibrillation catheter ablation: A meta‐analysis

AlTurki

Huynh

Dawas

et al. 2018

Journal of Arrhythmia

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Hot or cold? Feasibility, safety, and outcome after radiofrequency‐guided versus cryoballoon‐guided left atrial appendage isolation

Chen

Bordignon

Chun

et al. 2022

Journal of Arrhythmia

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Background: Left atrial appendage (LAA) isolation (LAAI) has been described as an adjunctive ablation strategy for patients with recurrent atrial tachyarrhythmia (ATa).Objectives: We compared the clinical impact of persistent durable LAAI between radiofrequency (RF)-guided wide-area LAAI and cryoballoon (CB)-guided ostial LAAI.Methods: Consecutive patients who underwent RF-or CB-guided LAAI were retrospectively analyzed. RF-guided LAAI was performed by combining linear ablation. CB-guided LAAI was performed by LAA ostial ablation. Following LAAI, the patients underwent an invasive remapping study. LAA closure was conducted if persistent durability was confirmed. The procedural data, LAAI durability, and ATa recurrence were assessed.Results: A total of 260 patients (RF: n = 201; CB: n = 59) undergoing LAAI were identified. The acute rate of procedural LAAI was higher in the CB group (CB:94.9% vs. RF:82.6%, p = .02) with a lower pericardial effusion incidence (CB:0% vs. RF:7.5%, p = .03). The 6-week durable LAAI was similar between the two groups (RF:78.3% vs. CB:66.0%, p = .103). During follow-up, one gastrointestinal bleeding and four stroke events including one subsequent intracranial bleeding leading to death occurred in the RF group, while one gastrointestinal bleeding occurred in the CB group.The 1-year ATa recurrence-free rate was higher in patients with durable LAAI following RF-guided LAAI (RF:76.3% vs. CB:56.7%, p = .0017). Multivariate analysis revealed RF-guided LAAI as a predictor of freedom from ATa recurrence (HR: 0.478, 95%CI: 0.336-0.823, p = .017).Conclusions: LAAI can be more readily and safely achieved by CB-guided ostial ablation. In patients with confirmed LAAI, however, the freedom from ATa recurrence was higher after RF-guided wide-area isolation.

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Rabbit model to simulate the residual conduction gaps after radiofrequency ablation on the anterior wall of left atrial appendage

Zhuge

et al. 2018

J Interv Card Electrophysiol

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Left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation: one-year clinical outcome after cryoballoon-based ablation

Abstract: Our findings indicated that LAA isolation as an adjunct to PVI improved 1-year outcomes in persistent AF compared with the PVI-only strategy using CB without an increase in thromboembolic complications.

Cited by 102 publications

References 17 publications

Left atrial appendage isolation in atrial fibrillation catheter ablation: A meta‐analysis

Left atrial appendage isolation in atrial fibrillation catheter ablation: A meta‐analysis

Hot or cold? Feasibility, safety, and outcome after radiofrequency‐guided versus cryoballoon‐guided left atrial appendage isolation

Rabbit model to simulate the residual conduction gaps after radiofrequency ablation on the anterior wall of left atrial appendage

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