1
|
Urbani A, Tohoku S, Bordignon S, Schaack D, Hirokami J, Urbanek L, Kheir JA, Schmidt B, Chun KRJ. Durable LAA isolation combining pulsed field ablation and radiofrequency linear lesions in a patient with a therapy refractory left atrial appendage tachycardia. J Interv Card Electrophysiol 2024; 67:1283-1286. [PMID: 39009786 DOI: 10.1007/s10840-024-01862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Treating atrial tachycardia (AT) originating from left atrial appendage (LAA) needs sometimes electrical isolation of LAA. We report a case of AT originating from LAA successfully treated with electrical isolation using the novel lattice-tip pulsed-field/radiofrequency ablation (PFA/RFA) catheter. A 55-year-old female patient with a history of three focal ablative attempts for a highly symptomatic AT originating from the LAA in different centers was admitted to our department for the recurrence of the clinical tachycardia. Electrical isolation of the LAA (LAAEI) was successfully performed with a lattice-tip PFA/RFA ablation catheter. Six weeks after the procedure, an invasive re-mapping study indicated a durable electrical LAA isolation; therefore, a 24-mm-sized LAA occlusion device (WATCHMAN FLX device, Boston Scientific, Plymouth, MN, USA) was implanted. DISCUSSION In this case, we successfully treated an atrial tachycardia originating from LAA using the recently approved lattice-tip PFA/RFA ablation catheter. The combination between two energy sources during the same procedure could potentially improve lesions transmurality offering a new promising solution for the treatment of complex atrial tachycardias.
Collapse
Affiliation(s)
- Andrea Urbani
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt Am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhem-Epstein-Straße 4, 60431, Frankfurt Am Main, Germany
- Cardiology and Arrhythmology Clinic, San Paolo University Hospital, University of Milan, Via Antonio Di Rudinì 8, 20142, Milan, Italy
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt Am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhem-Epstein-Straße 4, 60431, Frankfurt Am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt Am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhem-Epstein-Straße 4, 60431, Frankfurt Am Main, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt Am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhem-Epstein-Straße 4, 60431, Frankfurt Am Main, Germany
| | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt Am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhem-Epstein-Straße 4, 60431, Frankfurt Am Main, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt Am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhem-Epstein-Straße 4, 60431, Frankfurt Am Main, Germany
| | - Joseph Antoine Kheir
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt Am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhem-Epstein-Straße 4, 60431, Frankfurt Am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt Am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhem-Epstein-Straße 4, 60431, Frankfurt Am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt Am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhem-Epstein-Straße 4, 60431, Frankfurt Am Main, Germany.
- Die Sektion Medizin, Universität Zu Lübeck, Lübeck, Germany.
| |
Collapse
|
2
|
Bordignon S, Chun KJ, Schmidt B. Left atrial appendage isolation in PVI non-responder. Why incidental? Better to plan it, occlusion included. J Cardiovasc Electrophysiol 2023; 34:1162-1163. [PMID: 37125621 DOI: 10.1111/jce.15917] [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] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Stefano Bordignon
- Form Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt am Main, Germany
| | - Kr Julian Chun
- Form Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- Form Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt am Main, Germany
| |
Collapse
|
3
|
Sciacca V, Fink T, Eitel C, Heeger CH, Sano M, Reil JC, Eitel I, Kuck KH, Vogler J, Tilz RR. Repeat catheter ablation in patients with atrial arrhythmia recurrence despite durable pulmonary vein isolation. J Cardiovasc Electrophysiol 2022; 33:2003-2012. [PMID: 35761754 DOI: 10.1111/jce.15610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/18/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Arrhythmia recurrence after pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) is common and often linked to pulmonary vein reconnection. In patients with arrhythmia recurrences despite durable PVI the optimal ablation approach is unclear. The purpose of the present study was to analyze efficacy of extended ablation maneuvers in these patients and predictors of procedural success. METHODS Consecutive patients with durable PVI undergoing repeat ablation procedures were prospectively enrolled. Patients underwent substrate modification with creation of linear lesions and/or mechanism-specific atrial tachycardia (AT) ablation. 3D-mapping images were analyzed for the presence of left atrial (LA) low-voltage areas according to published scoring systems. RESULTS Seventy-four patients were analyzed. Mode of recurrence after durable PVI was AF in 27 patients (36.5%) and AT in 47 patients (63.5%). Linear lesion ablation was performed in 60 patients (81.1%). Twenty-four patients (32.4%) were treated for focal AT mechanisms. Mean follow-up was 565±342 days. Estimated arrhythmia-free survival after 24 months was significantly higher in patients with AT than in patients with AF as mode of recurrence after durable PVI (42.9±8.2% vs. 24.7±8.5%, p=0.023) and in patients without compared to patients with marked LA low-voltage areas (40.5±9.2% vs. 22.8±8.5%, p=0.041). The mode of recurrence after durable PVI was the only independent predictor of further arrhythmia recurrence after repeat ablation. CONCLUSION Arrhythmia-free survival following repeat ablation procedures in patients with durable PVI highly depends on mode of arrhythmia recurrence and the presence of LA low-voltage areas. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Vanessa Sciacca
- University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Thomas Fink
- University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Charlotte Eitel
- University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany
| | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research, Germany
| | - Makoto Sano
- University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany
| | - Jan-Christian Reil
- German Centre for Cardiovascular Research, Germany.,University Heart Center Lübeck, Department of Cardiology, Lübeck, Germany
| | - Ingo Eitel
- German Centre for Cardiovascular Research, Germany.,University Heart Center Lübeck, Department of Cardiology, Lübeck, Germany
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research, Germany.,LANS Cardio, Hamburg, Germany
| | - Julia Vogler
- University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany
| | - Roland Richard Tilz
- University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research, Germany
| |
Collapse
|
4
|
Tohoku S, Chen S, Bordignon S, Chun JK, Schmidt B. Hot or cold? Feasibility, safety, and outcome after radiofrequency-guided versus cryoballoon-guided left atrial appendage isolation. J Arrhythm 2022; 38:316-326. [PMID: 35785393 PMCID: PMC9237309 DOI: 10.1002/joa3.12691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Left atrial appendage (LAA) isolation (LAAI) has been described as an adjunctive ablation strategy for patients with recurrent atrial tachyarrhythmia (ATa). Objectives We compared the clinical impact of persistent durable LAAI between radiofrequency (RF)-guided wide-area LAAI and cryoballoon (CB)-guided ostial LAAI. Methods Consecutive patients who underwent RF- or CB-guided LAAI were retrospectively analyzed. RF-guided LAAI was performed by combining linear ablation. CB-guided LAAI was performed by LAA ostial ablation. Following LAAI, the patients underwent an invasive remapping study. LAA closure was conducted if persistent durability was confirmed. The procedural data, LAAI durability, and ATa recurrence were assessed. Results A total of 260 patients (RF: n = 201; CB: n = 59) undergoing LAAI were identified. The acute rate of procedural LAAI was higher in the CB group (CB:94.9% vs. RF:82.6%, p = .02) with a lower pericardial effusion incidence (CB:0% vs. RF:7.5%, p = .03). The 6-week durable LAAI was similar between the two groups (RF:78.3% vs. CB:66.0%, p = .103). During follow-up, one gastrointestinal bleeding and four stroke events including one subsequent intracranial bleeding leading to death occurred in the RF group, while one gastrointestinal bleeding occurred in the CB group.The 1-year ATa recurrence-free rate was higher in patients with durable LAAI following RF-guided LAAI (RF:76.3% vs. CB:56.7%, p = .0017). Multivariate analysis revealed RF-guided LAAI as a predictor of freedom from ATa recurrence (HR: 0.478, 95%CI: 0.336-0.823, p = .017). Conclusions LAAI can be more readily and safely achieved by CB-guided ostial ablation. In patients with confirmed LAAI, however, the freedom from ATa recurrence was higher after RF-guided wide-area isolation.
Collapse
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am MainGermany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am MainGermany
- Die Sektion MedizinUniversität zu LübeckLübeckGermany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am MainGermany
| | - Julian Kyoung‐Ryul Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am MainGermany
- Die Sektion MedizinUniversität zu LübeckLübeckGermany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am MainGermany
- Universitätsklinikum FrankfurtMedizinische Klinik 3‐ Klinik für KardiologieFrankfurtGermany
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Simultaneous appendage ligation and atrial ablation - is it worth the risk? Indian Pacing Electrophysiol J 2021; 21:80-81. [PMID: 33712110 PMCID: PMC7952887 DOI: 10.1016/j.ipej.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
7
|
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]
|
8
|
Yorgun H, Canpolat U, Okşul M, Şener YZ, Ateş AH, Crijns HJGM, Aytemir K. Long-term outcomes of cryoballoon-based left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation. Europace 2020; 21:1653-1662. [PMID: 31504432 DOI: 10.1093/europace/euz232] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Pulmonary vein isolation (PVI) alone in persistent atrial fibrillation (AF) is not as successful as in paroxysmal AF, and recent data indicate the key role of non-PV triggers. We aimed to assess the long-term safety and efficacy of left atrial appendage isolation (LAAi) as an adjunct to PVI using cryoballoon (CB) in persistent AF. METHODS AND RESULTS We compared 144 persistent AF patients (59 ± 10 years, 51% females) who underwent PVI combined with LAAi with a propensity-score matched cohort of 138 persistent AF patients (59 ± 6 years, 52% female) in whom PVI-only was performed. Baseline and follow-up data including electrocardiography (ECG), 24-h Holter ECG's, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a mean of 30.5 ± 5.6 months follow-up, 85 (61.6%) patients in the PVI-only group and 109 (75.7%) patients in the PVI+LAAi group were free of ATa after the index procedure (P = 0.008). Ischaemic stroke/transient ischaemic attack was detected in 4 (2.9%) patients in PVI-only group and in 5 (3.5%) patients in the PVI+LAAi group (P = 0.784). Cox regression analysis revealed that the PVI-only strategy was found as a significant predictor for recurrence (hazard ratio 3.01, 95% confidence interval 1.81-5.03; P < 0.001). CONCLUSIONS Our findings indicated that CB-based LAAi+PVI was associated with a favourable efficacy compared to PVI-only strategy in patients with persistent AF. Although ischaemic event rates were similar between the groups, rigorous adherence to anticoagulation regime is paramount in order to prevent thrombo-embolic complications.
Collapse
Affiliation(s)
- Hikmet Yorgun
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Sıhhıye,Ankara, Turkey.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Uğur Canpolat
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Sıhhıye,Ankara, Turkey
| | - Metin Okşul
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Sıhhıye,Ankara, Turkey
| | - Yusuf Ziya Şener
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Sıhhıye,Ankara, Turkey
| | - Ahmet Hakan Ateş
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Sıhhıye,Ankara, Turkey
| | - Harry J G M Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kudret Aytemir
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Sıhhıye,Ankara, Turkey
| |
Collapse
|
9
|
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.
Collapse
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.)
| |
Collapse
|
10
|
Zender N, Weise FK, Bordignon S, Herrmann E, Konstantinou A, Bologna F, Nagase T, Chen S, Chun KRJ, Schmidt B. Thromboembolism after electrical isolation of the left atrial appendage: a new indication for interventional closure? Europace 2020; 21:1502-1508. [PMID: 31230078 DOI: 10.1093/europace/euz161] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/14/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Left atrial appendage electrical isolation (LAAI) may improve the rhythm outcome in selected patients with atrial fibrillation (AF). Controversy exists if LAAI is associated with an increased rate of thromboembolic complications. We sought to assess the feasibility, efficacy, and safety of interventional left atrial appendage closure (LAAC) in comparison to oral anticoagulation (OAC) after electrical LAAI. METHODS AND RESULTS Weeks after index LAAI using the cryoballoon or a linear maze like ablation strategy patients' left atrial appendage was invasively remapped. In case of persistent LAAI, LAAC was performed. Patients who refused invasive remapping continued OAC. The primary endpoint was composed of any stroke or systemic embolism (SE) and the occurrence of intracardiac thrombus. Secondary endpoints included stroke/SE, major bleeding, and all-cause death. Of 166 patients (51% female; mean age 70 ± 8 years; mean CHAD2S2VASc score 3.4 ± 1.8) after LAAI, 94 patients received LAAC (LAAC group) and 72 continued OAC (no LAAC). After LAAC, 83% of patients received dual antiplatelet therapy for 6 weeks and aspirin thereafter. During a mean follow-up of 778 ± 630 days, 5 and 11 primary endpoint events were observed in the LAAC and no LAAC group, respectively [hazard ratio (HR) 0.27, 95% confidence interval (CI) 0.10-0.75; P = 0.010]. The calculated annual thromboembolic event rates were 6.9% (no LAAC) and 2.3% (LAAC), respectively. Left atrial appendage closure significantly reduced the incidence of stroke and SE (HR 0.31, CI 0.1-0.98; P = 0.04). CONCLUSION After electrical LAAI for rhythm control in AF patients, interventional LAAC was associated with fewer thromboembolic complications when compared with OAC.
Collapse
Affiliation(s)
- Niklas Zender
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Felix K Weise
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Eva Herrmann
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe-University, Frankfurt, Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Kyoung Ryul Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| |
Collapse
|
11
|
Zanchi S, Bianchini L, Bordignon S, Bologna F, Tohoku S, Chen S, Chun JKR, Schmidt B. Left atrial appendage (LAA) electrical isolation by Maze‐like catheter substrate modification in presence of LAA‐occluder device: A case report. Clin Case Rep 2020; 8:2021-2024. [PMID: 33088543 PMCID: PMC7562897 DOI: 10.1002/ccr3.3069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/12/2020] [Accepted: 05/30/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Simone Zanchi
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Julian K. R. Chun
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| |
Collapse
|
12
|
Varnavas V, Terasawa M, Sieira J, Abugattas JP, Ströker E, Paparella G, Iacopino S, Maj R, Osorio TG, De Greef Y, Bala G, Overeinder I, Brugada P, de Asmundis C, Chierchia GB. Electrophysiological findings in patients with isolated veins after cryoablation for paroxysmal atrial fibrillation. J Cardiovasc Med (Hagerstown) 2020; 21:641-647. [PMID: 32740497 DOI: 10.2459/jcm.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The main cause of atrial fibrillation recurrence after catheter ablation is pulmonary vein reconnection. The purpose of this retrospective study was to analyse the electophysiological findings in patients undergoing repeat procedures after an index cryoballoon ablation (CB-A) and presenting with permanency of pulmonary vein isolation (PVI) in all veins. In addition, we sought to compare the latter with a similar group of patients with reconnected veins at the redo procedure. METHODS A total of 132 patients (81 men, 60.7 ± 12.4 years) who underwent CB-A for paroxysmal atrial fibrillation (PAF) were enrolled. Indication for the redo procedure was symptomatic PAF in 83 (63%), persistent atrial fibrillation (PerAF) in 32 (24%) or persistent regular atrial tachycardia (RAT) in 17 (13%) patients. RESULTS Seventy-five (57%) patients presented a pulmonary vein reconnection (pulmonary vein group) during the redo procedure, whereas 57 (43%) had no pulmonary vein reconnection (non-pulmonary vein group). The non-pulmonary vein group exhibited significantly more non-pulmonary vein foci and atrial flutters than the pulmonary vein group after induction protocol (51 vs. 24%, P = 0.002 and 67 vs. 36%, P = 0.003, respectively). Twenty-two (29.3%) patients of the pulmonary vein group and 20 (35%) patients of the non-pulmonary vein group had atrial fibrillation/RAT recurrence after a mean follow-up of 12.5 ± 8 months. The survival analysis demonstrated no statistical significance in recurrence between both groups (log rank P = 0.358). CONCLUSION Atrial fibrillation/RAT recurrence in patients after CB-A with durable PVI is significantly associated with non-pulmonary vein foci and atrial flutters. No statistically different success rate regarding atrial fibrillation/RAT freedom was detected between the pulmonary vein and non-pulmonary vein groups after redoing RF-CA.
Collapse
Affiliation(s)
- Varnavas Varnavas
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Muryo Terasawa
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Juan Pablo Abugattas
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | | | | | - Saverio Iacopino
- Electrophysiology Unit, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Riccardo Maj
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Thiago Guimarães Osorio
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | | | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| |
Collapse
|
13
|
Fink T, Ouyang F, Heeger CH, Sciacca V, Reissmann B, Keelani A, Schütte C, Wohlmuth P, Maurer T, Rottner L, Eitel C, Eitel I, Rillig A, Metzner A, Kuck KH, Tilz RR, Vogler J. Management of thrombus formation after electrical isolation of the left atrial appendage in patients with atrial fibrillation. Europace 2020; 22:1358-1366. [DOI: 10.1093/europace/euaa174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/02/2020] [Indexed: 12/30/2022] Open
Abstract
Abstract
Aims
Left atrial appendage (LAA) electrical isolation (LAAEI) in addition to pulmonary vein isolation is an emerging catheter-based therapy to treat symptomatic atrial fibrillation. Previous studies found high incidences of LAA thrombus formation after LAAEI. This study sought to analyse therapeutic strategies aiming at the resolution of LAA thrombi and prevention of thromboembolism.
Methods and results
Left atrial appendage electrical isolation was conducted via creation of left atrial linear lesions or cryoballoon ablation. Follow-up including transoesophageal echocardiography was conducted. In patients with LAA thrombus, oral anticoagulation (OAC) was adjusted until thrombus resolution was documented. Percutaneous LAA closure (LAAC) under use of a cerebral protection device was conducted in case of medically refractory LAA thrombi. Left atrial appendage thrombus was documented in 54 of 239 analysed patients who had undergone LAAEI. Thrombus resolution was documented in 39/51 patients (72.2%) with available follow-up after adjustment of OAC. Twenty-nine patients underwent LAAC and 10 patients were kept on OAC after LAAEI. No thromboembolic events or further LAA thrombi were documented after 553 ± 443 days of follow-up in these patients. Persistent LAA thrombi despite adaption of OAC was documented in 12/51 patients. One patient remained on OAC until the end of follow-up, while LAAC with a cerebral protection device was performed in 11 patients in the presence of LAA thrombus without complications.
Conclusion
Left atrial appendage thrombus formation is common after LAAEI. Adjustment of OAC leads to LAA thrombus resolution in most patients. Left atrial appendage closure in the presence of LAA thrombi might be a feasible option in case of failed medical treatment.
Collapse
Affiliation(s)
- Thomas Fink
- Department of Cardiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Center of Cardiac Arrhythmias, Fuwai Hospital of the Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, China
| | - Christian-Hendrik Heeger
- Department of Cardiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Germany
| | - Vanessa Sciacca
- Department of Cardiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Bruno Reissmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiac Electrophysiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Ahmad Keelani
- Department of Cardiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | | | - Peter Wohlmuth
- Asklepios Proresearch, Lohmühlenstraße 5, 20099 Hamburg, Germany
| | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Laura Rottner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiac Electrophysiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Charlotte Eitel
- Department of Cardiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Ingo Eitel
- Department of Cardiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiac Electrophysiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiac Electrophysiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Germany
| | - Roland Richard Tilz
- Department of Cardiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Germany
| | - Julia Vogler
- Department of Cardiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
| |
Collapse
|
14
|
Parikh V, Rasekh A, Mohanty S, Yarlagadda B, Atkins D, Bommana S, Turagam M, Jeffery C, Carroll H, Nydegger C, Jaeger M, Dar T, Cheng J, Gopinnathanair R, Dibiase L, Lee R, Horton R, Natale A, Lakkireddy D. Exclusion of electrical and mechanical function of the left atrial appendage in patients with persistent atrial fibrillation: differences in efficacy and safety between endocardial ablation vs epicardial LARIAT ligation (the EXCLUDE LAA study). J Interv Card Electrophysiol 2019; 57:409-416. [DOI: 10.1007/s10840-019-00657-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
|
15
|
Tilz RR, Sano M, Vogler J, Fink T, Eitel C, Heeger CH. Fourth-Generation Cryoablation Based Left Atrial Appendage Isolation for the Treatment of Persistent Atrial Fibrillation: First Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1830-1836. [PMID: 31812979 PMCID: PMC6913233 DOI: 10.12659/ajcr.918196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is an effective treatment strategy for patients with paroxysmal atrial fibrillation (AF), yet it is associated with limited success rates in patients with persistent AF (PersAF). The left atrial appendage (LAA) was recently identified as a target of catheter ablation especially in PVI non-responders and LAA-isolation (LAAI) by cryoballoon or radiofrequency was shown to be effective. Recently the fourth-generation cryoballoon (CB4) was introduced to clinical practice. Here we are demonstrating the first case report of CB4-based LAAI followed by LAA-closure in a patient with PersAF. CASE REPORT A 67-year-old male patient presented with symptomatic PersAF and thromboembolism due to LAA-thrombus. After resolving the LAA-thrombus cryoballoon based PVI and empirical LAAI was successfully performed. To prevent further thromboembolism LAA-closure was successfully performed after 6 weeks. On short-term follow-up (12 weeks) the patients stayed in stable sinus rhythm. CONCLUSIONS Fourth-generation cryoballoon based ablation seems to be an effective treatment strategy for LAAI.
Collapse
Affiliation(s)
- Roland Richard Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein (UKSH) - Campus Luebeck, Luebeck, Germany
| | - Makoto Sano
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein (UKSH) - Campus Luebeck, Luebeck, Germany
| | - Julia Vogler
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein (UKSH) - Campus Luebeck, Luebeck, Germany
| | - Thomas Fink
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein (UKSH) - Campus Luebeck, Luebeck, Germany
| | - Charlotte Eitel
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein (UKSH) - Campus Luebeck, Luebeck, Germany
| | - Christian-H Heeger
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein (UKSH) - Campus Luebeck, Luebeck, Germany
| |
Collapse
|
16
|
Chen S, Schmidt B, Tohoku S, Trolese L, Bordignon S, Chun KRJ. Transesophageal echocardiography-guided closure of electrically isolated left atrial appendage to constrain a rapidly growing thrombus despite anticoagulation and sinus rhythm. J Cardiovasc Electrophysiol 2019; 31:247-249. [PMID: 31749201 DOI: 10.1111/jce.14284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Luca Trolese
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| |
Collapse
|
17
|
Bordignon S, Bologna F, Chen S, Konstantinou A, Tsianakas N, Tohoku S, Trolese L, Chun KJ, Schmidt B. Percutaneous left atrial appendage closure in the presence of thrombus: A feasibility report. J Cardiovasc Electrophysiol 2019; 30:2858-2863. [PMID: 31638713 DOI: 10.1111/jce.14246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with a left atrial appendage thrombus (LAAT) despite oral anticoagulation (OAC) are at high risk of thromboembolism (TE) and a relevant proportion of LAAT do not resolve under continued OAC. Left atrial appendage closure (LAAC) in the presence of LAAT was anecdotally described as a therapeutic option to prevent TE in the patients. OBJECTIVE To describe the feasibility of LAAC despite LAAT in consecutive patients. METHODS We searched the LAAC database of our center to identify patients in whom a LAAC was performed despite evidence of a thrombus in the LAA. All procedures were performed under transesophageal echocardiography guidance, no angiographies were performed to avoid LAAT dislocation. An Amulet Occluder device was preferred to allow proximal implantation and sealing of the LAA. RESULTS Nine patients were identified. The mean age was 68.1 ± 10.7 years, four were female, mean CHADSVASC and HASBLED were 3.6 ± 1.7 and 3.0 ± 1.0. Eight of nine patients were on OAC, one patient was under lone aspirin therapy because of bleeding. The mean distance between the LAAT and the estimated landing zone was 18 ± 6 mm, the minimal distance was 11 mm. The mean landing zone was 21 ± 3 mm, devices with a mean size of 25 ± 4 mm were chosen for implantation. All implantation succeeded, only two patients required an intraprocedural replacement. No procedural complication nor short term thromboembolic complication during a follow up of 138 ± 149 days were recorded. CONCLUSION In the presented series a percutaneous LAAC despite a LAAT resulted to be feasible and safe.
Collapse
Affiliation(s)
- Stefano Bordignon
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Fabrizio Bologna
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Shaoje Chen
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Athanasios Konstantinou
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Nikolaos Tsianakas
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Shota Tohoku
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Luca Trolese
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Kr Julian Chun
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Boris Schmidt
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| |
Collapse
|
18
|
Schmidt B, Chun KJ. Stroke Risk After Electrical Left Atrial Appendage Isolation. J Am Coll Cardiol 2019; 74:1029-1030. [DOI: 10.1016/j.jacc.2019.06.044] [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: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022]
|
19
|
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]
|
20
|
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
| |
Collapse
|
21
|
Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Nagase T, Chun KRJ. Left appendage isolation plus left appendage occlusion on top of pulmonary vein isolation, a therapeutic option for a PVI nonresponder with persistent atrial fibrillation? J Cardiovasc Electrophysiol 2019; 30:1177-1178. [DOI: 10.1111/jce.13881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Shaojie Chen
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Boris Schmidt
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Stefano Bordignon
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Laura Perrotta
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Fabrizio Bologna
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Takahiko Nagase
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - K. R. Julian Chun
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| |
Collapse
|
22
|
Gadiyaram VK, Mohanty S, Gianni C, Trivedi C, Al-Ahmad A, Burkhardt DJ, Gallinghouse JG, Hranitzky PM, Horton RP, Sanchez JE, Della Rocca DG, Di Biase L, Price MJ, Couts L, Gibson D, Natale A. Thromboembolic events and need for anticoagulation therapy following left atrial appendage occlusion in patients with electrical isolation of the appendage. J Cardiovasc Electrophysiol 2019; 30:511-516. [PMID: 30623500 DOI: 10.1111/jce.13838] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/27/2018] [Accepted: 12/30/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Electrical isolation of the left atrial appendage (LAA) is an important adjunctive ablation strategy in patients with nonparoxysmal atrial fibrillation (AF). Patients who have impaired LAA contractility following isolation may require long-term oral anticoagulant (OAC) therapy irrespective of their CHADS2 -VASc score. Percutaneous LAA occlusion (LAAO) is a potential alternative to life-long OAC therapy. We aimed to assess the rate of OAC discontinuation and thromboembolic (TE) events following percutaneous LAAO in patients who underwent LAA electrical isolation (LAAI). METHODS This is a retrospective two-center study of patients who underwent percutaneous LAAO following LAAI. Patients with at least 3-month follow-up were included in the study. The antithrombotic therapy and TE events at the time of the last follow-up were noted. RESULTS The LAA was successfully occluded in 162 (with Watchman device in 140 [86.4%] and Lariat in 22 [13.6%]). A total of 32 patients had leaks detected on the 45-day transesophageal echocardiogram (TEE); 21 (15%) Watchman and 11 (50%) Lariat cases (P = 0.0001). Two (one Watchman and one Lariat) of the 32 leaks were more than 5 mm. After the 45-day TEE, 150 (92.6%) patients were off-OAC. No TE events were reported in the 150 patients who stopped the anticoagulants. Four (2.47%) patients experienced stroke following the LAAO (three Watchman and one Lariat) procedure while on-OAC, two of which were fatal. At the median follow-up of 18.5 months, 159 (98.15%) patients were off-anticoagulant. CONCLUSION Up to 98% of patients with LAAI could safely discontinue OAC after undergoing the appendage closure procedure.
Collapse
Affiliation(s)
- Varuna K Gadiyaram
- Department of Interventional Electrophysiology, Scripps Clinic, La Jolla, California
| | - Sanghamitra Mohanty
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas.,Dell Medical School, University of Texas, Austin, Texas
| | - Carola Gianni
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Chintan Trivedi
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Amin Al-Ahmad
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - David J Burkhardt
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Joseph G Gallinghouse
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Patrick M Hranitzky
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Rodney P Horton
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Javier E Sanchez
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | | | - Luigi Di Biase
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas.,Department of Biomedical Engineering, University of Texas, Austin, Texas.,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.,Department of Internal Medicine and Cardiology, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Matthew J Price
- Department of Interventional Electrophysiology, Scripps Clinic, La Jolla, California
| | - Linda Couts
- Department of Interventional Electrophysiology, Scripps Clinic, La Jolla, California
| | - Douglas Gibson
- Department of Cardiac Electrophysiology, Scripps Clinic, La Jolla, CA
| | - Andrea Natale
- Department of Interventional Electrophysiology, Scripps Clinic, La Jolla, California.,Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas.,Dell Medical School, University of Texas, Austin, Texas.,Department of Biomedical Engineering, University of Texas, Austin, Texas.,Department of Electrophysiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of Cardiology, Stanford University, Stanford, California
| |
Collapse
|
23
|
Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Nagase T, Chun KRJ. Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol). J Cardiovasc Electrophysiol 2019; 30:272-283. [DOI: 10.1111/jce.13818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/11/2018] [Accepted: 11/28/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Shaojie Chen
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Boris Schmidt
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Stefano Bordignon
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Laura Perrotta
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Fabrizio Bologna
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Takahiko Nagase
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - K. R. Julian Chun
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| |
Collapse
|
24
|
Fink T, Schlüter M, Heeger CH, Lemeš C, Maurer T, Reissmann B, Rottner L, Santoro F, Tilz RR, Alessandrini H, Rillig A, Mathew S, Wohlmuth P, Fang Q, Lee R, Ouyang F, Kuck KH, Metzner A. Combination of Left Atrial Appendage Isolation and Ligation to Treat Nonresponders of Pulmonary Vein Isolation. JACC Clin Electrophysiol 2018; 4:1569-1579. [DOI: 10.1016/j.jacep.2018.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 10/27/2022]
|
25
|
Tilz RR, Liosis S, Vogler J, Reil JC, Eitel C, Heeger CH. Left atrial appendage thrombus formation less than 24 hours after empirical cryoballoon-based left atrial appendage isolation: A serious warning. HeartRhythm Case Rep 2018; 5:124-127. [PMID: 30891407 PMCID: PMC6404379 DOI: 10.1016/j.hrcr.2018.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Roland Richard Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Spyridon Liosis
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Julia Vogler
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Jan C Reil
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Charlotte Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Christian-H Heeger
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| |
Collapse
|
26
|
|
27
|
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
| |
Collapse
|