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Anwar AM. Morphological and functional assessment of the left atrial appendage in daily practice: a comprehensive approach using basic and advanced echocardiography with practical tips. J Cardiovasc Imaging 2024; 32:12. [PMID: 39069633 DOI: 10.1186/s44348-024-00017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 07/30/2024] Open
Abstract
Cardioembolic stroke is the most serious and life-threatening complication of atrial fibrillation (AF), with an associated mortality up to 30% at 12 months. Approximately 47% of thrombi in valvular AF and 91% of thrombi in nonvalvular AF are localized in the left atrial appendage (LAA). Therefore, identification or exclusion of LAA thrombi is critical in many clinical situations. It is essential to assess LAA morphology and function using imaging modalities (particularly echocardiography) before, during, and after interventional procedures such as AF ablation and LAA occlusion. This review article describes the anatomical, physiological, and pathological background of the LAA, followed by an assessment of different echocardiographic modalities. Many practical points are included to improve the diagnostic accuracy and to minimize errors during image acquisition and interpretation. In each clinical scenario where LAA is the crucial target, specific and essential information and parameters are collected.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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2
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Gong S, Zhou J, Li B, Kang S, Ma X, Cai Y, Guo Y, Hu R, Zhang X. The Association of Left Atrial Appendage Morphology to Atrial Fibrillation Recurrence After Radiofrequency Ablation. Front Cardiovasc Med 2021; 8:677885. [PMID: 34458330 PMCID: PMC8387723 DOI: 10.3389/fcvm.2021.677885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: The probability of late recurrent atrial fibrillation (AF) after radiofrequency ablation (RFA) has not yet been fully clarified. This study aims to study the association of left atrial appendage (LAA) morphology with AF recurrence after RFA. Methods: We retrospectively enrolled 84 patients (24 patients had persistent AF, 60 patients had paroxysmal AF) who underwent RFA in Shanghai East Hospital from June 2014 to May 2018. The mean follow-up of these patients was 618.6 days. According to preoperative transesophageal echocardiography (TEE), the morphology feature of LAA was classified and evaluated by two classification methods. The first method was divided into chicken-wing, windsock, cactus, and cauliflower, and the second method was divided into one lobe, two lobes, and multiple lobes. The correlation between morphological feature of LAA and the recurrence rate of AF after RFA was analyzed. Results: During follow-up, 12 patients (50%) and 10 patients (16.7%) had AF recurrence in persistent and paroxysmal AF, respectively. The LAA morphology was associated with the recurrence of AF after RFA with the chicken-wing highest recurrence risk (68.2%). The structure type of LAA was also related to the AF recurrence rate (p < 0.01). Compared with one lobe and multiple lobes, two lobes (recurrence, 47.6%) were more likely associated with the recurrence of AF (p < 0.02). Logistic regression analysis showed that the chicken-wing group had a higher risk of recurrence after RFA (OR = 8.13, p = 0.004), and the windsock group had a lower risk of recurrence (OR = 0.17, p = 0.002). Conclusion: The morphological feature of LAA is related to the recurrence risk of AF after RFA. LAA morphology assessment can predict the risk of AF recurrence.
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Affiliation(s)
- Shiyu Gong
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jian Zhou
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bingyu Li
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Sheng Kang
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaoye Ma
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ying Cai
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yang Guo
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rui Hu
- Department of Laboratory, Taiyuan Hospital Health Center for Woman and Children, Taiyuan, China
| | - Xumin Zhang
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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3
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Romero J, Gabr M, Patel K, Briceno D, Diaz JC, Alviz I, Trivedi C, Mohanty S, Polanco D, Della Rocca DG, Lakkireddy D, Natale A, Di Biase L. Efficacy and safety of left atrial appendage electrical isolation during catheter ablation of atrial fibrillation: an updated meta-analysis. Europace 2021; 23:226-237. [PMID: 33324978 DOI: 10.1093/europace/euaa266] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/16/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Left atrial appendage electrical isolation (LAAEI) has been shown to improve freedom from all-atrial arrhythmia recurrence in patients with non-paroxysmal atrial fibrillation (AF). The aim of this study is to investigate the long-term efficacy and safety outcomes of LAAEI in patients with non-paroxysmal AF undergoing catheter ablation. METHODS AND RESULTS A systematic review of Medline, Cochrane, and Embase was performed for clinical studies evaluating the benefit of LAAEI in non-paroxysmal AF. Nine studies with a total of 2336 patients were included (mean age: 65 ± 9 years, 63% male). All studies included patients with persistent AF, long-standing persistent AF, or both. At a mean follow-up of 40.5 months, patients who underwent LAAEI had significantly higher freedom from all-atrial arrhythmia recurrence than patients who underwent standard ablation alone [69.3% vs. 46.4%; risk ratio (RR) 0.54; 95% confidence interval (CI) 0.42-0.69; P < 0.0001]. A 46% relative risk reduction and 22.9% absolute risk reduction in atrial-arrhythmia recurrence was noted with LAAEI. Rates of cerebral thromboembolism were not significantly different between the two groups (LAAEI 3% vs. standard ablation 1.6%, respectively; RR 1.76; 95% CI 0.61-5.04; P = 0.29). Furthermore, there was no significant difference in the acute procedural complication rates between the two groups (LAAEI 4% vs. standard ablation 3%, respectively; RR 1.29; 95% CI 0.83-2.02; P = 0.26). CONCLUSION At long-term follow-up, LAAEI led to a significantly higher improvement in freedom from all-atrial arrhythmia recurrence in patients with non-paroxysmal AF, when compared to standard ablation alone. Importantly, this benefit was achieved without an increased risk of acute procedural complications or cerebral thromboembolic events.
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Affiliation(s)
- Jorge Romero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York, USA
| | - Mohamed Gabr
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York, USA
| | - Kavisha Patel
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York, USA
| | - David Briceno
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York, USA
| | - Juan Carlos Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York, USA
| | - Isabella Alviz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Dalvert Polanco
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York, USA
| | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York, USA
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4
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Lellouche N, Arrouasse R, Ternacle J, Gallet R, Hermida JS, Hamon D, Juliard JM, Pasquie JL, Dhanjal T, Teiger E, Le Corvoisier P. Atrial fibrillation evolution and rhythm control strategy following left appendage closure: new insights from the prospective FLAAC registry. BMC Cardiovasc Disord 2021; 21:227. [PMID: 33941095 PMCID: PMC8091509 DOI: 10.1186/s12872-021-01994-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous left atrial appendage (LAA) closure is an alternative to oral anticoagulation (OAC) for atrial fibrillation (AF) patients with high thromboembolism risk, particularly with contraindications to OAC. The LAA itself could possess proarrhythmogenic properties. As patients undergoing LAA closure could be candidates for cardioversion or ablation, we aimed to evaluate AF disease progression following LAA closure and the outcome of patients undergoing a rhythm control strategy after the procedure. METHODS The prospective multicenter French Nationwide Observational LAA Closure Registry (FLAAC) comprises 33 French interventional cardiology departments. Patients were included if they fulfilled the following criteria: history of non-valvular AF, successful LAA closure and long-term ECG follow-up. RESULTS A total of 331 patients with successful LAA closure were enrolled in the study. Patients mean age was 75.4 ± 0.5 years. The study population was characterized by a high thromboembolic risk (CHA2DS2-VASc score: 4.5 ± 0.1) and frequent comorbidities. The median follow-up was 11.9 months. One hundred and nineteen (36.0%) patients were in sinus rhythm (SR) at baseline. Among SR patients, documented AF was observed in 16 (13.4%) patients whereas 15 (7.1%) patients in AF at baseline restored SR, at the end of follow up. Finally, only 13 patients (4%) underwent procedures to restore SR without complications during the follow-up. CONCLUSIONS The vast majority of patients undergoing LAA closure have the same AF status at baseline and one year after the index procedure. During the follow-up, a very small proportion (4%) of our population underwent procedures to restore SR without complications whatever the post-procedural antithrombotic strategy was.
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Affiliation(s)
- Nicolas Lellouche
- Cardiology Unit Henri Mondor University Hospital Paris XII, Creteil, France. .,AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.
| | | | - Julien Ternacle
- Cardiology Unit Henri Mondor University Hospital Paris XII, Creteil, France
| | - Romain Gallet
- Cardiology Unit Henri Mondor University Hospital Paris XII, Creteil, France
| | | | - David Hamon
- Cardiology Unit Henri Mondor University Hospital Paris XII, Creteil, France
| | - Jean-Michel Juliard
- Department of Cardiology, Bichat Hospital, APHP, University Paris VII, DHU FIRE, Sorbonne Paris-Cité, INSERM U-1148, Paris, France
| | - Jean-Luc Pasquie
- Montpellier University Hospital, CNRS UMR9214-Inserm U1046-PHYMEDEXP, Montpellier, France
| | - Tarvinder Dhanjal
- Department of Electrophysiology, University Hospital Coventry & Warwickshire, Coventry, UK
| | - Emmanuel Teiger
- Cardiology Unit Henri Mondor University Hospital Paris XII, Creteil, France
| | - Philippe Le Corvoisier
- Inserm, CIC 1430, Henri Mondor University Hospital, Creteil, France.,Inserm, U955 team 3, Henri Mondor University Hospital, Creteil, France
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5
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De Martino G, Nasso G, Gasperetti A, Moscarelli M, Mancusi C, Della Ratta G, Calvanese C, Mitacchione G, Bonifazi R, Di Bari N, Vassallo E, Schiavone M, Gaudino M, Forleo GB, Speziale G. Targeting Bachmann's bundle in hybrid ablation for long-standing persistent atrial fibrillation: a proof of concept study. J Interv Card Electrophysiol 2021; 64:273-280. [PMID: 33683552 DOI: 10.1007/s10840-021-00971-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/22/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Catheter-based or surgical procedures in patients with long-standing persistent atrial fibrillation (LSPAF) remain a challenge. As a result, different approaches including hybrid (surgical and endocardial) ablation have been developed. Bachmann's bundle (BB) is a mainly epicardial structure capable of sustaining arrhythmic reentry that could be involved in the development and perpetuation of atrial fibrillation. We investigated the efficacy and safety of an adjunctive BB ablation in LSPAF patients undergoing hybrid ablation. METHODS In a two-arm non-randomized study, consecutive LSPAF patients undergoing epicardial isolation of pulmonary veins with left atrial posterior wall (box lesion) with (n = 30, BB group) and without additional BB ablation (n = 30, CONV group) were enrolled in the study. All patients underwent an endocardial procedure within 6 weeks post-surgery to assess for potential lesion gaps and additional atrial substrate modification. The primary endpoint was freedom from AF through 12 months of follow-up. RESULTS The two-staged hybrid ablation was successfully completed in all patients. One-year freedom from atrial arrhythmias recurrence rates was 96.6% in the BB group vs 76.6% in the CONV group (p = 0.025). At procedure completion, 30 (100%) and 17 (56%) patients had a spontaneous cardioversion in BB and CONV group, respectively (p < 0.001). No significant differences in quality of life or complication rates were observed. CONCLUSIONS This initial experience shows, for the first time, that adjunctive BB ablation in the setting of hybrid ablation for LSPAF is a feasible and effective approach in increasing maintenance of sinus rhythm without increasing complication rates.
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Affiliation(s)
| | | | - Alessio Gasperetti
- Ospedale Luigi Sacco - Polo Universitario, Via G.B. Grassi 74, 20157, Milan, Italy
| | | | | | | | | | | | | | | | | | - Marco Schiavone
- Ospedale Luigi Sacco - Polo Universitario, Via G.B. Grassi 74, 20157, Milan, Italy
| | | | - Giovanni B Forleo
- Ospedale Luigi Sacco - Polo Universitario, Via G.B. Grassi 74, 20157, Milan, Italy.
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6
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Hussein AA, Jaber WA, Wazni OM. Not Safe at Any Velocity: Left Atrial Appendage Emptying and Cessation of Anticoagulation After Appendage Electrical Isolation. Circ Arrhythm Electrophysiol 2021; 14:e009409. [PMID: 33464945 DOI: 10.1161/circep.120.009409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ayman A Hussein
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology (A.A.H., O.M.W.), Cleveland Clinic, OH
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology (A.A.H., O.M.W.), Cleveland Clinic, OH
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Section of Cardiac Imaging (W.A.J.), Cleveland Clinic, OH
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7
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Fink T, Vogler J, Heeger CH, Sano M, Sciacca V, Reissmann B, Wohlmuth P, Keelani A, Schütte C, Eitel C, Eitel I, Maurer T, Rottner L, Rillig A, Mathew S, Metzner A, Ouyang F, Kuck KH, Tilz RR. Impact of Left Atrial Appendage Closure on LAA Thrombus Formation and Thromboembolism After LAA Isolation. JACC Clin Electrophysiol 2020; 6:1687-1697. [DOI: 10.1016/j.jacep.2020.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022]
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8
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Romero J, Di Biase L, Mohanty S, Trivedi C, Patel K, Parides M, Alviz I, Diaz JC, Natale V, Sanchez J, Della Rocca DG, Yang R, Mohanty P, Gianni C, Horton R, Burkhardt D, Al-Ahmad A, Lakkireddy D, Natale A. Long-Term Outcomes of Left Atrial Appendage Electrical Isolation in Patients With Nonparoxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2020; 13:e008390. [DOI: 10.1161/circep.120.008390] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Left atrial appendage electrical isolation (LAAEI) has been proposed for the treatment of nonparoxysmal atrial fibrillation (AF). The long-term clinical outcomes of this approach remain unclear. The objective of our study was to investigate the incremental benefit and safety of LAAEI in patients undergoing catheter ablation for nonparoxysmal AF.
Methods:
Propensity score-matched analysis was performed using a prospective registry database from 2010 to 2014. All patients in the LAAEI group were matched based on baseline characteristics, echocardiographic parameters, and procedural ablation techniques.
Results:
We identified 1842 patients who underwent catheter ablation for nonparoxysmal AF. Propensity score matching yielded 1092 patients, 546 patients with LAAEI, and 546 patients without LAAEI. At 5-year follow-up, overall freedom from all-atrial arrhythmia recurrence, off-antiarrhythmic drugs, in patients who underwent LAAEI was 68.9% versus 50.2% in those who underwent standard ablation alone (
P
<0.001). Acute complication rates were similar between groups (LAAEI 1.3% versus non-LAAEI 0.73%,
P
=0.36). At 5-year follow-up, 382 (70%) patients in the LAAEI group remained on oral anticoagulation versus 217 (39.7%) in the non-LAAEI group. At 5-year follow-up, thromboembolic events occurred in 15/546 (2.75%) in the LAAEI group and 4/546 (0.73%) in the non-LAAEI group (
P
=0.01). No thromboembolic events occurred in either group on-oral anticoagulation. In patients who were off-oral anticoagulation, at 5-year follow-up, thromboembolic events occurred in 15/164 (9.1%) in the LAAEI group and 4/329 (1.2%) in the non-LAAEI group (
P
<0.001).
Conclusions:
At 5-year follow-up, LAAEI was associated with significantly higher freedom from all-atrial arrhythmia recurrence in patients with persistent and long-standing persistent AF without increasing acute procedural complication rate. In patients off-oral anticoagulation, there appears to be a higher risk of thromboembolic events in the LAAEI group.
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Affiliation(s)
- Jorge Romero
- The Cardiac Arrhythmia Center at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., L.D.B., K.P., M.P., I.A., J.C.D., R.Y.)
| | - Luigi Di Biase
- The Cardiac Arrhythmia Center at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., L.D.B., K.P., M.P., I.A., J.C.D., R.Y.)
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | - Kavisha Patel
- The Cardiac Arrhythmia Center at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., L.D.B., K.P., M.P., I.A., J.C.D., R.Y.)
| | - Michael Parides
- The Cardiac Arrhythmia Center at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., L.D.B., K.P., M.P., I.A., J.C.D., R.Y.)
| | - Isabella Alviz
- The Cardiac Arrhythmia Center at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., L.D.B., K.P., M.P., I.A., J.C.D., R.Y.)
| | - Juan C. Diaz
- The Cardiac Arrhythmia Center at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., L.D.B., K.P., M.P., I.A., J.C.D., R.Y.)
| | - Veronica Natale
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | - Javier Sanchez
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | - Domenico G. Della Rocca
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | - Ruike Yang
- The Cardiac Arrhythmia Center at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., L.D.B., K.P., M.P., I.A., J.C.D., R.Y.)
- Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, China (R.Y.)
| | - Prasant Mohanty
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | - David Burkhardt
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.)
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9
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Ishiguchi H, Yoshida M, Ishikura M, Kawabata T, Oda T. Successful ablation of biatrial tachycardia with preserved electrical activation of left atrial appendage by unidirectional connection via Bachmann’s bundle: A case report. Indian Pacing Electrophysiol J 2020; 20:166-169. [PMID: 32305464 PMCID: PMC7384361 DOI: 10.1016/j.ipej.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/11/2020] [Accepted: 04/07/2020] [Indexed: 11/14/2022] Open
Abstract
A 57-year-old man underwent his seventh ablation session for atrial tachycardia (AT). His previous ablations involved several regions of the right atrium (RA) and left atrium (LA). The AT was characterized as biatrial tachycardia with a circuit involving the mitral annulus and septal RA. The AT was terminated by ablation through the insertion site of Bachmann’s bundle (BB) in both atria. After 3 months, the patient underwent his eighth ablation session because of AT recurrence. Activation maps showed that the connection from the RA to LA and vice versa was maintained via BB and the coronary sinus, respectively. The ablation target to interrupt the AT circuit was the mitral isthmus (MI), not BB, because BB supplied the electrical activation of the left atrial appendage (LAA) via a unidirectional electrical connection from the RA to LA. Ablation attempts from within the coronary sinus were performed to target the epicardial connection in the MI and led to complete blockage of the connection from the LA to RA. Otherwise, the connection from the RA to LA was preserved via BB. The patient was free of symptoms and anti-arrhythmic drugs at the 4-month follow-up. However, he had a high risk of electrical isolation of the LAA because extensive ablations had been performed; the strategy of targeting the MI contributed to the balance between preserving the electrical activation of the LAA and treating the biatrial tachycardia. Verification of the connective pathway between the two atria might be helpful to determine the optimal target.
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10
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Karim N, Ho SY, Nicol E, Li W, Zemrak F, Markides V, Reddy V, Wong T. The left atrial appendage in humans: structure, physiology, and pathogenesis. Europace 2019; 22:5-18. [DOI: 10.1093/europace/euz212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/12/2019] [Indexed: 01/01/2023] Open
Abstract
Abstract
For many years, the left atrial appendage (LAA) was considered a dormant embryological remnant; however, it is a structurally complex and functional organ that contributes to cardiac haemodynamic changes and volume homeostasis through both its contractile properties and neurohormonal peptide secretion. When dysfunctional, the LAA contributes to thrombogenesis and subsequent increased predisposition to cardioembolic events. Consequently, the LAA has gained much attention as a therapeutic target to lower this risk. In addition, attention has focused on the LAA in its role as an electrical trigger for atrial tachycardia and atrial fibrillation with ablation of the LAA to achieve electrical isolation showing promising results in the maintenance of sinus rhythm. This in-depth review explores the structure, physiology and pathophysiology of the LAA, as well as LAA intervention and their sequelae.
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Affiliation(s)
- Nabeela Karim
- Department of Cardiology, The Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, Sydney Street, London, UK
| | - Siew Yen Ho
- Department of Cardiology, The Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, Sydney Street, London, UK
| | - Edward Nicol
- Department of Cardiology, The Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, Sydney Street, London, UK
| | - Wei Li
- Department of Cardiology, The Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, Sydney Street, London, UK
| | - Filip Zemrak
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | - Vias Markides
- Department of Cardiology, The Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, Sydney Street, London, UK
| | - Vivek Reddy
- Helmsley Centre for Cardiac Electrophysiology, Mount Sinai Hospital, New York City, NY, USA
| | - Tom Wong
- Department of Cardiology, The Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, Sydney Street, London, UK
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11
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Di Biase L, Romero J, Briceno D, Valderrabano M, Sanchez JE, Della Rocca DG, Mohanty P, Horton R, Gallinghouse GJ, Mohanty S, Trivedi C, Beheiry S, Gianni C, Elayi CS, Burkhardt JD, Natale A. Evidence of relevant electrical connection between the left atrial appendage and the great cardiac vein during catheter ablation of atrial fibrillation. Heart Rhythm 2019; 16:1039-1046. [DOI: 10.1016/j.hrthm.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Indexed: 11/28/2022]
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12
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Bordignon S, Chen S, Perrotta L, Bologna F, Nagase T, Konstantinou A, Weise F, Fuernkranz A, Schmidt B, Chun JKR. Durability of cryoballoon left atrial appendage isolation: Acute and invasive remapping electrophysiological findings. Pacing Clin Electrophysiol 2019; 42:646-654. [DOI: 10.1111/pace.13690] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/11/2019] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Stefano Bordignon
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Felix Weise
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | | | - Boris Schmidt
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Julian K. R. Chun
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
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13
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14
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AlTurki A, Huynh T, Dawas A, AlTurki H, Joza J, Healey JS, Essebag V. Left atrial appendage isolation in atrial fibrillation catheter ablation: A meta-analysis. J Arrhythm 2018; 34:478-484. [PMID: 30327692 PMCID: PMC6174377 DOI: 10.1002/joa3.12095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/17/2018] [Accepted: 06/19/2018] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Ahmed AlTurki
- Division of CardiologyMcGill University Health CenterMontrealQuebecCanada
| | - Thao Huynh
- Division of CardiologyMcGill University Health CenterMontrealQuebecCanada
| | - Ahmed Dawas
- Faculty of MedicineMcGill UniversityMontrealQuebecCanada
| | | | - Jacqueline Joza
- Division of CardiologyMcGill University Health CenterMontrealQuebecCanada
| | - Jeff S. Healey
- Population Health Research InstituteHamiltonOntarioCanada
| | - Vidal Essebag
- Division of CardiologyMcGill University Health CenterMontrealQuebecCanada
- Hôpital Sacré‐Coeur de MontréalMontrealQuebecCanada
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15
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Lessons learned in attempting catheter-based interatrial electrical disconnection for nonpharmacologic rate control of atrial fibrillation or flutter. J Interv Card Electrophysiol 2018; 57:333-343. [DOI: 10.1007/s10840-018-0448-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
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16
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Harding I, Bastiaenen R, Khan P, Marciniak A, Sharma R, Gallagher MM. A Fibrillating Left Atrial Appendage During Sinus Rhythm. JACC Clin Electrophysiol 2018; 3:524-525. [PMID: 29759611 DOI: 10.1016/j.jacep.2016.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/06/2016] [Accepted: 09/08/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Idris Harding
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St George's University of London, London, United Kingdom
| | - Rachel Bastiaenen
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St George's University of London, London, United Kingdom
| | - Parisha Khan
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St George's University of London, London, United Kingdom
| | - Anna Marciniak
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St George's University of London, London, United Kingdom
| | - Rajan Sharma
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St George's University of London, London, United Kingdom
| | - Mark M Gallagher
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St George's University of London, London, United Kingdom.
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17
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Tilz RR, Eitel C. Left Atrial Appendage Electric Isolation for Treatment of Atrial Fibrillation: Experimental Approach or Standard of Care? JACC Clin Electrophysiol 2018; 4:121-123. [PMID: 29600776 DOI: 10.1016/j.jacep.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 09/29/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
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18
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Romero J, Michaud GF, Avendano R, Briceño DF, Kumar S, Carlos Diaz J, Mohanty S, Trivedi C, Gianni C, Della Rocca D, Proietti R, Perrotta L, Bordignon S, Chun JKR, Schmidt B, Garcia M, Natale A, Di Biase L. Benefit of left atrial appendage electrical isolation for persistent and long-standing persistent atrial fibrillation: a systematic review and meta-analysis. Europace 2018; 20:1268-1278. [DOI: 10.1093/europace/eux372] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/05/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jorge Romero
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
| | - Gregory F Michaud
- Department of Cardiology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, EE. UU, USA
| | - Ricardo Avendano
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
| | - David F Briceño
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, University of Sydney, Hawkesbury Rd & Darcy Road, Westmead NSW, Sydney, Australia
| | - Juan Carlos Diaz
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
| | - Sanghamitra Mohanty
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
| | - Chintan Trivedi
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
| | - Carola Gianni
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
| | - Domenico Della Rocca
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
| | - Riccardo Proietti
- Dipartimento di Cardiologia, Luigi Sacco, Ospedale Luigi Saco, Via G.B Grassi, 74, Milano MI, Italy
| | - Laura Perrotta
- Department of Cardiology and Angiology, Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, Frankfurt/Main, Alemania, Germany
| | - Stefano Bordignon
- Department of Cardiology and Angiology, Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, Frankfurt/Main, Alemania, Germany
| | - Julian K R Chun
- Department of Cardiology and Angiology, Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, Frankfurt/Main, Alemania, Germany
| | - Boris Schmidt
- Department of Cardiology and Angiology, Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, Frankfurt/Main, Alemania, Germany
| | - Mario Garcia
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
| | - Andrea Natale
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
| | - Luigi Di Biase
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, USA
- Department of Cardiology, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, USA
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19
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Left Atrial Appendage Electrical Isolation for Treatment of Recurrent Atrial Fibrillation: A Meta-Analysis. JACC Clin Electrophysiol 2018; 4:112-120. [PMID: 29600775 PMCID: PMC9902022 DOI: 10.1016/j.jacep.2017.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/02/2017] [Accepted: 07/20/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES In this study, the authors sought to perform a meta-analysis of controlled studies assessing the relationship between left atrial appendage (LAA) electrical isolation (EI) and recurrent atrial fibrillation (AF). BACKGROUND LAA triggers could play an important role in AF and can be treated with complete EI of the LAA via surgical or percutaneous approaches. METHODS We conducted a meta-analysis of all controlled studies published as of November 21, 2016, assessing the relationship between left atrial appendage electrical isolation (LAAEI) and recurrent AF. The primary endpoint was atrial tachycardia (AT) or AF recurrence after the post-procedure blanking period. The association between LAAEI and AT/AF was estimated using random-effects modeling. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the DerSimonian and Laird method. RESULTS We identified 7 studies including 1,037 patients; LAAEI was performed in 566 patients (55%). LAAEI was associated with a significantly lower rate of AT/AF recurrence in the primary analysis (OR: 0.38; 95% CI: 0.16 to 0.90; p = 0.02). The association between LAAEI and recurrent AT/AF was strongest in a sensitivity analysis restricted to studies of percutaneous LAAEI (OR: 0.22; 95% CI: 0.11 to 0.46; p < 0.001; 5 studies, n = 623). LAAEI was not associated with thromboembolism (OR: 0.50; 95% CI: 0.18 to 1.39; p = 0.18; 5 studies, n = 767), although these studies either incorporated LAA occlusion (3 studies, n = 552 patients) or follow-up echocardiography to assess LAA function (2 studies, n = 215 patients) to inform antithrombotic strategies. CONCLUSIONS LAAEI is associated with a significant reduction in recurrent AT/AF. Randomized trials are required to confirm the efficacy and long-term safety of LAAEI and to determine the optimal concomitant antithrombotic strategy.
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20
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E Gul E, Boles U, Haseeb S, Flood J, Bansal A, Glover B, Redfearn D, Simpson C, Abdollah H, Baranchuk A, Michael KA. Left Atrial Appendage characteristics in patients with Persistent Atrial Fibrillation undergoing catheter ablation (LAAPAF Study). J Atr Fibrillation 2017; 9:1526. [PMID: 29250273 DOI: 10.4022/jafib.1526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 01/09/2017] [Accepted: 01/15/2017] [Indexed: 12/13/2022]
Abstract
Background Despite technological and scientific efforts, the recurrence rate of persistent atrial fibrillation (AF) remains high. Several studies have shown that in addition to pulmonary vein (PV) isolation other non-PV triggers, particularly left atrial appendage may be the source of initiation and maintenance of AF. There are few studies showing the role of left atrial appendage (LAA) isolation in order to obtain higher success rate in persistent AF patients. Objective We analyzed the LAA volume, volume index and shape relative to the LA in patients with persistent AF undergoing AF ablation. Methods Fifty-nine consecutive patients with persistent AF who underwent catheter ablation were enrolled. Computerized tomography (CT) was performed in order to assess left atrial and PV anatomy including the LAA. Digital subtraction software (GE Advantage Workstation 4.3) was used to separate the LAA from the LA and calculate: LA volume (LAV), LA volume index (LAV/body surface area), LAA volume (LAAV), LAA volume index (LAA volume/LA volume), and LAA morphology [chicken wing (CW) or non-chicken wing (NCW)]. Results The mean age was 64.6 ± 9.8 years, 44 % male, and LA diameter 47.6 ± 7.8 mm. Median follow-up (FU) was 13 months. All patients had antral isolation of PVs and ablation of complex fractionation ± linear ablation (roof line/superior coronary sinus/mitral line). Among 59 patients with persistent AF, 26 (44 %) patients were diagnosed with AF recurrences. Mean LAV was 145.0 ± 45.9 ml, LAVI 68.9 ± 20.0 ml/m2, LAAV 10.3 ± 4.0 ml, and LAAVI 7.3 ± 2.7 ml/m2. LAA shape was non-chicken wing (NCW) in the majority of patients (51 %). LAA parameters were not significantly different between patients with and without AF recurrence (LAAV 11.0 ± 4.3 ml vs. 9.7 ± 3.8 ml, p=0.26; LAAVI 7.5 ± 3.0 ml/m2 vs. 7.2 ± 2.5 ml/m2, p=0.71; LAA shape of NCW 50 % vs 52 %, p=0.75, respectively). LAV was significantly correlated with the LAAV (r: o.47, p=0.009). The incidence of NCW LAA was significantly higher in patients with previous stroke/TIA (80 % vs. 20 %, p=0.04). Conclusion The LAA anatomical characteristics (volume/volume index and the shape) were comparable in patients with/out AF recurrence post PVI. It remains to be determined if additional LAA isolation will impact outcomes in patients with persistent AF.
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Affiliation(s)
- Enes E Gul
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Usama Boles
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Sohaib Haseeb
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Justin Flood
- Department of Diagnostic Radiology, Queens University, Kingston, ON, Canada
| | - Ayuish Bansal
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Benedict Glover
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Damian Redfearn
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Chris Simpson
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Hoshiar Abdollah
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Kevin A Michael
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
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21
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Romero J, Natale A, Di Biase L. Atrial fibrillation ablation beyond pulmonary veins: The role of left atrial appendage. Rev Port Cardiol 2017; 36 Suppl 1:31-41. [PMID: 29126892 DOI: 10.1016/j.repc.2017.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022] Open
Abstract
The role of pulmonary vein isolation in patients with non-paroxysmal atrial fibrillation (AF) is only modest. Several studies have demonstrated the role of the left atrial appendage (LAA) in initiating and maintaining of this arrhythmia. We review in this article the incremental benefit in free-arrhythmia recurrence of LAA electrical isolation in patients undergoing procedures for persistent AF or long standing persistent AF either using radiofrequency ablation, cryoablation or Lariat device implantation. Likewise, acute complications, anticoagulation and the risk of ischemic stroke after LAA electrical isolation (LAAEI) are analyzed. LAAEI in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from all atrial arrhythmias in patients with persistent AF and long standing persistent atrial fibrillation (LSPAF) without increasing acute procedural complications and without raising the risk of ischemic stroke.
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Affiliation(s)
- Jorge Romero
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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22
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Romero J, Natale A, Di Biase L. Atrial fibrillation ablation beyond pulmonary veins: The role of left atrial appendage. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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23
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Romero J, Natale A, Di Biase L. Left atrial appendage electrical isolation for atrial fibrillation: "ICE and FIRE". PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:751-753. [PMID: 28436533 DOI: 10.1111/pace.13093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/20/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jorge Romero
- Division of Cardiology at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Natale
- Division of Cardiology at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Luigi Di Biase
- Division of Cardiology at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Reissmann B, Rillig A, Wissner E, Tilz R, Schlüter M, Sohns C, Heeger C, Mathew S, Maurer T, Lemes C, Fink T, Wohlmuth P, Santoro F, Riedl J, Ouyang F, Kuck KH, Metzner A. Durability of wide-area left atrial appendage isolation: Results from extensive catheter ablation for treatment of persistent atrial fibrillation. Heart Rhythm 2017; 14:314-319. [DOI: 10.1016/j.hrthm.2016.11.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Indexed: 11/25/2022]
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25
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Di Biase L, Natale A. To "isolate" or "not to isolate," the left atrial appendage, "that is the question". J Interv Card Electrophysiol 2016; 47:261-263. [PMID: 27541304 DOI: 10.1007/s10840-016-0174-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Silver Zone, Bronx, NY, 10467-2400, USA.
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, USA.
- Department of Biomedical Engineering, University of Texas, Austin, TX, USA.
- Department of Cardiology, University of Foggia, Foggia, Italy.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Scripps Clinic, San Diego, CA, USA
- Dell Medical School, Austin, TX, USA
- California Pacific Medical Center, San Francisco, CA, USA
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