Impact of Left Atrial Appendage Closure on LAA Thrombus Formation and Thromboembolism After LAA Isolation.
arrhythmia recurrence
atrial fibrillation
catheter ablation
left atrial appendage closure
left atrial appendage isolation
left atrial thrombus
stroke
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
14 12 2020
14 12 2020
Historique:
received:
15
10
2019
revised:
30
06
2020
accepted:
08
07
2020
entrez:
18
12
2020
pubmed:
19
12
2020
medline:
19
8
2021
Statut:
ppublish
Résumé
This study sought to evaluate the safety and effectiveness of electrical isolation of the left atrial appendage (LAAEI) as well as the status of left atrial appendage closure (LAAC) in these patients. Catheter-based LAAEI is increasingly performed for treatment of symptomatic atrial fibrillation and pulmonary vein isolation nonresponders. Previous studies indicate an increased incidence of thromboembolic events after LAAEI despite effective oral anticoagulation. Interventional LAAC may prevent cardioembolic events after LAAEI but data regarding safety, feasibility, and efficacy of LAAC in this clinical setting are scarce. Consecutive patients who underwent LAAEI at 2 German tertiary care hospitals were analyzed. A total of 270 patients underwent LAAEI by radiofrequency ablation in 255 (94.4%), cryoballoon ablation in 12 (4.4%), and by a combination of both techniques in 3 cases (1.1%). Stroke or transient ischemic attack occurred in 24 of 244 (9.8%) individuals with available follow-up. LAA thrombus formation was found in 53 patients (19.6%). A total of 150 patients underwent LAAC after LAAEI. No LAA thrombus was documented in any patient who underwent LAAC. Of the patients who underwent LAAEI, 67.6% were in sinus rhythm after a mean of 682.7 ± 61.7 days. LAA flow after LAAEI but not arrhythmia recurrence was identified as an independent predictor of stroke and/or transient ischemic attack or LAA thrombus (p < 0.0001). Sinus rhythm was documented in about two-third of patients undergoing LAAEI as treatment of therapy refractory atrial arrhythmias. LAAC potentially prevents LAA thrombus formation and thromboembolism.
Sections du résumé
OBJECTIVES
This study sought to evaluate the safety and effectiveness of electrical isolation of the left atrial appendage (LAAEI) as well as the status of left atrial appendage closure (LAAC) in these patients.
BACKGROUND
Catheter-based LAAEI is increasingly performed for treatment of symptomatic atrial fibrillation and pulmonary vein isolation nonresponders. Previous studies indicate an increased incidence of thromboembolic events after LAAEI despite effective oral anticoagulation. Interventional LAAC may prevent cardioembolic events after LAAEI but data regarding safety, feasibility, and efficacy of LAAC in this clinical setting are scarce.
METHODS
Consecutive patients who underwent LAAEI at 2 German tertiary care hospitals were analyzed.
RESULTS
A total of 270 patients underwent LAAEI by radiofrequency ablation in 255 (94.4%), cryoballoon ablation in 12 (4.4%), and by a combination of both techniques in 3 cases (1.1%). Stroke or transient ischemic attack occurred in 24 of 244 (9.8%) individuals with available follow-up. LAA thrombus formation was found in 53 patients (19.6%). A total of 150 patients underwent LAAC after LAAEI. No LAA thrombus was documented in any patient who underwent LAAC. Of the patients who underwent LAAEI, 67.6% were in sinus rhythm after a mean of 682.7 ± 61.7 days. LAA flow after LAAEI but not arrhythmia recurrence was identified as an independent predictor of stroke and/or transient ischemic attack or LAA thrombus (p < 0.0001).
CONCLUSIONS
Sinus rhythm was documented in about two-third of patients undergoing LAAEI as treatment of therapy refractory atrial arrhythmias. LAAC potentially prevents LAA thrombus formation and thromboembolism.
Identifiants
pubmed: 33334448
pii: S2405-500X(20)30601-0
doi: 10.1016/j.jacep.2020.07.003
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1687-1697Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Author Disclosures Dr. Fink received travel grants from SentreHeart. Dr. Heeger has received travel grants and research grants from Medtronic, Claret Medical, SentreHeart, Biosense Webster, and Cardiofocus; and has received speaker honoraria from Cardiofocus, Medtronic, and Novartis. Dr. Eitel has received speaker honoraria from Bayer, Biosense Webster, Impulse Dynamic, St. Jude Medical/Abbott, Pfizer, Liva Nova, Zoll, Boston Scientific, Novartis, Daiichi Sankyo, and AstraZeneca; and has received travel grants from St. Jude Medical, Biotronik, and Medtronic. Dr. Rillig has received travel grants from Biosense, Hansen Medical, EP Solutions, Medtronic, and St. Jude Medical; has received lecture fees from St. Jude Medical, Medtronic, and Boehringer Ingelheim; and took part in the Boston Scientific electrophysiology fellowship. Dr. Mathew has received speaker honoraria and travel grants from Medtronic. Dr. Metzner has received speaker honoraria and travel grants from Medtronic. Prof. Kuck received research grants and personal fees from St. Jude Medical, Medtronic, and Biosense Webster. Prof. Tilz has received research grants from Medtronic and Biotronik; received travel grants from Biosense Webster, Medtronic, Abbott, SentreHeart, and Daiichi Sankyo; received Speakers Bureau and/or proctor honoraria from Biosense Webster, Medtronic, Abbott, SentreHeart, and Daiichi Sankyo; and has served as a consultant of Biosense Webster and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.