Safety and feasibility of combined atrial fibrillation ablation and left atrial appendage occlusion after left atrial appendage electrical isolation.
Aged
Anticoagulants
/ therapeutic use
Atrial Appendage
/ surgery
Atrial Fibrillation
/ drug therapy
Catheter Ablation
/ methods
Combined Modality Therapy
Echocardiography, Transesophageal
Electrocardiography
Feasibility Studies
Female
Fluoroscopy
Humans
Male
Operative Time
Patient Safety
Platelet Aggregation Inhibitors
/ therapeutic use
Retrospective Studies
Risk Factors
Stroke
/ prevention & control
Thromboembolism
/ prevention & control
Atrial fibrillation
Catheter ablation
Left atrial appendage
Left atrial appendage occlusion
Watchman™
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
11
04
2019
accepted:
24
07
2019
pubmed:
5
8
2019
medline:
20
1
2021
entrez:
5
8
2019
Statut:
ppublish
Résumé
To demonstrate the feasibility of combining left atrial appendage electrical isolation (LAAEI) with left atrial appendage occlusion (LAAO) to increase efficacy of persistent/longstanding atrial fibrillation (PLAF) catheter ablation (CA) while mitigating risk of left atrial appendage (LAA) thrombus. CA for atrial fibrillation (AF) plus LAAO is safe and feasible. LAAEI may improve freedom from recurrence in PLAF but may increase LAA thrombus. We performed 42 concomitant procedures in patients with PLAF. After standard lesions, LAAEI was performed. LAAO immediately followed ablation. If 3-month transesophageal echocardiogram (TEE) was benign, oral anticoagulation (OAC) was transitioned to dual antiplatelet therapy for 3 more months. Patients were 71.1 ± 8.5 years old, with CHADS2-VASc of 3.3 ± 1.1 and HAS-BLED of 2.5 ± 1.4. Twenty-eight of 42 patients (66.7%) were completely AF free over an average follow-up of 18.6 ± 8.6 months. The AF-free survival estimate was 94.5% at 1 year. There was no thromboembolism (TE) during the follow-up. There were six non-significant leaks acutely and six non-significant leaks at 6 months. There were three device-related thrombi, although 2/3 stopped OAC prematurely. A combined procedure is feasible and effective in treating arrhythmia and stroke risk associated with PLAF. The risk of TE despite OAC after LAAEI supports simultaneous LAAO.
Sections du résumé
OBJECTIVE
OBJECTIVE
To demonstrate the feasibility of combining left atrial appendage electrical isolation (LAAEI) with left atrial appendage occlusion (LAAO) to increase efficacy of persistent/longstanding atrial fibrillation (PLAF) catheter ablation (CA) while mitigating risk of left atrial appendage (LAA) thrombus.
BACKGROUND
BACKGROUND
CA for atrial fibrillation (AF) plus LAAO is safe and feasible. LAAEI may improve freedom from recurrence in PLAF but may increase LAA thrombus.
METHODS
METHODS
We performed 42 concomitant procedures in patients with PLAF. After standard lesions, LAAEI was performed. LAAO immediately followed ablation. If 3-month transesophageal echocardiogram (TEE) was benign, oral anticoagulation (OAC) was transitioned to dual antiplatelet therapy for 3 more months.
RESULTS
RESULTS
Patients were 71.1 ± 8.5 years old, with CHADS2-VASc of 3.3 ± 1.1 and HAS-BLED of 2.5 ± 1.4. Twenty-eight of 42 patients (66.7%) were completely AF free over an average follow-up of 18.6 ± 8.6 months. The AF-free survival estimate was 94.5% at 1 year. There was no thromboembolism (TE) during the follow-up. There were six non-significant leaks acutely and six non-significant leaks at 6 months. There were three device-related thrombi, although 2/3 stopped OAC prematurely.
CONCLUSION
CONCLUSIONS
A combined procedure is feasible and effective in treating arrhythmia and stroke risk associated with PLAF. The risk of TE despite OAC after LAAEI supports simultaneous LAAO.
Identifiants
pubmed: 31377973
doi: 10.1007/s10840-019-00603-1
pii: 10.1007/s10840-019-00603-1
doi:
Substances chimiques
Anticoagulants
0
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
43-55Commentaires et corrections
Type : CommentIn
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