Managing the Left Atrial Appendage in Atrial Fibrillation: Current State of the Art

Khawar, Waqaar; Smith, Nathan; Masroor, Saqib

doi:10.1016/j.athoracsur.2017.05.036

Cited by 5 publications

(3 citation statements)

References 70 publications

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“…As implanted LAAO devices could fail, in patients undergoing cardioplegic cardiac surgery, we recommend an advanced intraoperative examination of the implanted LAAO in order to decide whether it is possible to explant the device, regardless of the potential risk of device dislocation by the performed procedure. Surgical amputation of the LAA as well as clip exclusion are safe and feasible procedures to improve the outcome of AF patients by reducing the risk for stroke and other thromboembolic events, with minimal general risk of device-related thrombosis ( 5 , 10 ).…”

Section: Discussionmentioning

confidence: 99%

Atrial Thrombosis Caused by a Dislocated Left Atrial Appendage Closure Device After Mitral Valve Replacement

et al. 2020

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A patient with a left atrial appendage occlusion device underwent mitral valve replacement. Later, the patient developed a left atrial thrombosis with thromboembolic myocardial infarction caused by a dislocation of the occlusion device. Exclusion of the device and non–device-based appendage occlusion may have prevented the patient from experiencing postoperative complications ( Level of Difficulty: Intermediate. ).

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Section: Discussionmentioning

confidence: 99%

Atrial Thrombosis Caused by a Dislocated Left Atrial Appendage Closure Device After Mitral Valve Replacement

et al. 2020

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“…Hence, surgical removal of the LAA in animals may determine a reduction in pulmonary vein flow, an increase in trans -mitral diastolic flow [ 46 ] and a 50% drop in cardiac output [ [ 46 ]]. In practice, however, possibly due to a counterbalancing effect of the contralateral auricle, LAA closing procedures do not cause adverse effects or significant changes in human cardiac physiology [ [ 47 ]].…”

Section: The Left Atrial Auriclementioning

confidence: 99%

A highly-detailed anatomical study of left atrial auricle as revealed by in-vivo computed tomography

Mantini,

Corradi,

Ricci

et al. 2023

Heliyon

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“…Notably, despite many studies demonstrating non‐PV triggers are additional mechanisms for maintenance of persistent AF, results from the limited randomized trials do not show clinical benefit 4 . Common anatomical sites are the superior vena cava (SVC), ligament of Marshall, coronary sinus (CS), crista terminalis, left atrial posterior wall (LApos), and left atrial appendage (LAA) 5–7 . There are also spatially non‐conserved sites, revealed by dedicated mapping techniques with promising non‐randomized clinical data and benefit compared to PVI alone in a recent large meta‐analysis of over 3200 patients 3,8 …”

Section: Introductionmentioning

confidence: 99%

Spectral characterization and impact of stepwise ablation protocol including LAA electrical isolation on persistent AF

Zaman

Shi

et al. 2021

Pacing Clinical Electrophis

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Objectives To study how left atrial appendage electrical isolation (LAAEI) impacts atrial dominant frequency (DF) in patients with long‐standing persistent atrial fibrillation (LSPAF). Background LAAEI is associated with a high probability of freedom from atrial fibrillation (AF) and spectral analysis may identify high‐frequency sources. How LAAEI impacts the AF dynamics and the subgroup of LSPAF patients in whom LAAEI would be most beneficial, is unclear. Methods Twenty patients with LSPAF were included in the study. Fast Fourier transforms (FFT) were performed on atrial electrograms recorded from 13 sites in the LA and RA. The highest peak frequency was defined as DF. Results There was no significant difference in DF between atrial sites except for at the superior vena cava which had the lowest DF at baseline. Stepwise ablation consisting of circumferential pulmonary vein isolation and a linear ablation set of mitral isthmus and roof significantly reduced the DF within the coronary sinus (CS) (5.93 ± 0.98 Hz vs. 5.09 ± 0.72 Hz, p < .05) and the LA posterior wall (LApos) (6.26 ± 0.92 Hz vs. 5.43 ± 0.98 Hz, p < .01). LAAEI preferentially further decreased the DF at the LApos (p < .01), but not at the CS. In cases where there was < 13.6% reduction in the DF of the LApos following the stepwise ablation, the addition of LAAEI was associated with an increased restoration of sinus rhythm (55%, p < .05). Conclusion LAAEI in addition to stepwise ablation results in further reduction of the DF in the LApos, which is associated with acute termination of AF and favorable ablation outcome.

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Managing the Left Atrial Appendage in Atrial Fibrillation: Current State of the Art

Cited by 5 publications

References 70 publications

Atrial Thrombosis Caused by a Dislocated Left Atrial Appendage Closure Device After Mitral Valve Replacement

Atrial Thrombosis Caused by a Dislocated Left Atrial Appendage Closure Device After Mitral Valve Replacement

A highly-detailed anatomical study of left atrial auricle as revealed by in-vivo computed tomography

Spectral characterization and impact of stepwise ablation protocol including LAA electrical isolation on persistent AF

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