Left atrial catheter ablation in patients with previously implanted left atrial appendage closure devices

Wintgens, Lisette I S; Klaver, Martijn N; Swaans, Martin J.; Alipour, Arash; Balt, Jippe C.; Dijk, Vincent F. van; Rensing, Benno J.; Wijffels, Maurits C.E.F.; Boersma, Lucas V.A.

doi:10.1093/europace/euy237

Cited by 9 publications

(12 citation statements)

References 20 publications

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“…The Lasso circular mapping catheter might hawk the pre‐existing device especially a disc‐like occluder and lead to device dislocation, or ablation on the surface of device to cause perforation of the membrane and lead to the leak of device. But for a well‐experienced operator, the success rate is similar between the two strategies (CA first or LAAC first) according to recent reports 16,17 . However, most literatures regarding the combination procedure are CA first and it is more suitable for the logistic process in most catheter centers.…”

Section: Important Issues To Be Considered In the Combination Proceduresmentioning

confidence: 90%

“…But for a well‐experienced operator, the success rate is similar between the two strategies (CA first or LAAC first) according to recent reports. 16 , 17 However, most literatures regarding the combination procedure are CA first and it is more suitable for the logistic process in most catheter centers.…”

Section: Important Issues To Be Considered In the Combination Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Combination of ablation and left atrial appendage closure as “One‐stop” procedure in the treatment of atrial fibrillation: Current status and future perspective

Jiang

Hao

et al. 2021

Pacing Clinical Electrophis

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Atrial fibrillation (AF), the most common arrhythmia, is a major cause of stroke and systemic embolism. Left atrial appendage closure (LAAC) has been proved to be noninferior to traditional Vitamin K antagonists (VKAs) as well as novel oral anticoagulants (NOACs), which is becoming an important alternative to prevent stroke in non‐valvular AF. Catheter‐based AF ablation (CA) is recommended to be a standard of care in patients with AF refractory to drug therapy due to a better rhythm control and improvement of life quality than antiarrhythmic drugs. Theoretically, the one‐stop combination with LAAC and CA tends to bring more benefits in patients with AF, as it not only relieves symptoms, but also reduces the risk of stroke significantly. However, several important questions still need to be considered in the combination procedure although quite a few attempts have already been made in clinical practice. This review provides a comprehensive update on the concept, technique, perioperative management, benefits and other critical issues of the “one‐stop” procedure.

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Section: Important Issues To Be Considered In the Combination Proceduresmentioning

confidence: 90%

Section: Important Issues To Be Considered In the Combination Proceduresmentioning

confidence: 99%

Combination of ablation and left atrial appendage closure as “One‐stop” procedure in the treatment of atrial fibrillation: Current status and future perspective

Jiang

Hao

et al. 2021

Pacing Clinical Electrophis

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“…Numerous reports exist of LAA thrombus formation and stroke following LAA electrical isolation despite uninterrupted OAC . LAAC in combination with LAA electrical isolation is feasible when performed by experienced operators . However, high rates of severe peridevice leak have been reported when LAA electrical isolation is performed following LAAC, perhaps due to an effect on LAA geometry and device sizing .…”

Section: Laac and Doac In Unique Subgroupsmentioning

confidence: 99%

“…[55][56][57] LAAC in combination with LAA electrical isolation is feasible when performed by experienced operators. 58,59 However, high rates of severe peridevice leak have been reported when LAA electrical isolation is performed following LAAC, perhaps due to an effect on LAA geometry and device sizing. 60 The impact of extensive left atrial ablation at the time of LAAC on DRT is unknown, leading experienced operators to recommend a 6month waiting period between LAAC and electrical isolation of the LAA.…”

Section: Af Ablation and Left Atrial Appendage Electrical Isolationmentioning

confidence: 99%

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

Black‐Maier

Piccini

Granger

2019

Cardiovasc electrophysiol

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Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and confers a fivefold increased risk for stroke. Cardioembolic stroke secondary to AF is a devastating event, but is largely preventable with appropriate oral anticoagulation (OAC). The PROTECT and PREVAIL trials demonstrated that the WATCHMAN left atrial appendage closure (LAAC) device in combination with short‐term warfarin therapy is noninferior to long‐term warfarin with respect to a composite endpoint of stroke, cardiovascular death, and systemic embolism. Importantly, the WATCHMAN confers a significant reduction in life‐threatening bleeding compared to OAC. Although direct‐acting oral anticoagulant (DOAC) are superior to warfarin in eligible patients, several important AF populations exist in whom left atrial appendage (LAA) closure may be preferable to DOAC. Populations warranting strong consideration of LAAC include patients with contraindications to DOAC, end‐stage renal disease, prior intracranial hemorrhage, recurrent gastrointestinal bleeding, and patients undergoing transcatheter aortic valve replacement or left atrial electrical isolation. Device‐related thrombosis is an important complication of LAAC, and DOAC may be preferential to warfarin for prevention and treatment of this complication remains unexplored. Prospective clinical trials comparing DOAC to LAAC in these unique populations are either ongoing or needed.

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“…15,16 Despite the promising results, the limitation of previous studies should be highlighted, including a small sample size (e.g., less than ten patients), [17][18][19] lack of long-term follow-up (e.g., less than 6 months), [20][21][22] and noncombined ablation and LAAC. 23,24 In this study, we evaluated the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety of the combination of ablation and LAAC.…”

Section: Introductionmentioning

confidence: 99%

The long‐term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and meta‐analysis

Sun

et al. 2021

Cardiovasc electrophysiol

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Background: Combined ablation and left atrial appendage closure (LAAC) is an alternative for atrial fibrillation patients with a high risk of stroke. However, the long-term outcomes of this combined procedure remain elusive.Methods: PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included.Results: A total of 16 studies comprising 1428 patients were enrolled. The pooled long-term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval[CI]: 0.59-0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI:1.00-1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow-up was 0.01 (95% CI: 0.00-0.02). Meanwhile, of the periprocedural adverse events, phrenic nerve palsy, intracoronary air embolus, device embolization, and periprocedural death had a rate of 0.00 (95% CI: 0.00-0.00), procedure-related bleeding events of 0.03 (95% CI: 0.02-0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI: 0.00-0.01). Moreover, for the long-term adverse events, device dislocation, intracranial bleeding, pericardial effusion requiring or not requiring intervention, and all-cause mortality had a rate of 0.00 (95% CI: 0.00-0.00), device embolization of 0.01 (95% CI: 0.00-0.01), and other bleeding events of 0.01 (95% CI: 0.00-0.03). Conclusion:This meta-analysis suggests that the combined atrial ablation and LAAC is an effective and safe strategy with long-term benefits.

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Left atrial catheter ablation in patients with previously implanted left atrial appendage closure devices

Cited by 9 publications

References 20 publications

Combination of ablation and left atrial appendage closure as “One‐stop” procedure in the treatment of atrial fibrillation: Current status and future perspective

Combination of ablation and left atrial appendage closure as “One‐stop” procedure in the treatment of atrial fibrillation: Current status and future perspective

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

The long‐term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and meta‐analysis

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