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Lee RJ, Hanke T. The Strengths and Weaknesses of Left Atrial Appendage Ligation or Exclusion (LARIAT, AtriaClip, Surgical Suture). Card Electrophysiol Clin 2023; 15:201-213. [PMID: 37076232 DOI: 10.1016/j.ccep.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Left atrial appendage (LAA) epicardial exclusion has been associated with addressing 2 potential deleterious consequences attributed to the LAA, namely, thrombus formation and an arrhythmogenic contributor in advanced forms of atrial fibrillation. With more than 60 years of history, the surgical exclusion of the LAA has been firmly established. Numerous approaches have been used for surgical LAA exclusion including surgical resections, suture ligation, cutting and non-cutting staples, and surgical clips. Additionally, a percutaneous epicardial LAA ligation approach has been developed. A discussion of the various epicardial LAA exclusion approaches and their efficacy will be discussed, along with the salient beneficial affects on LAA thrombus formation, LAA electrical isolation and neuroendocrine homeostasis.
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Affiliation(s)
- Randall J Lee
- Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Avenue, Box 1354, San Francisco, CA 94143, USA.
| | - Thorsten Hanke
- Department of Cardiovascular Surgery, ASKLEPIOS Klinikum Harburg, Abteilung Herzchirurgie, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany
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Lee RJ, Hanke T. The Strengths and Weaknesses of Left Atrial Appendage Ligation or Exclusion (LARIAT, AtriaClip, Surgical Suture). Interv Cardiol Clin 2022; 11:205-217. [PMID: 35361465 DOI: 10.1016/j.iccl.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Left atrial appendage (LAA) epicardial exclusion has been associated with addressing 2 potential deleterious consequences attributed to the LAA, namely, thrombus formation and an arrhythmogenic contributor in advanced forms of atrial fibrillation. With more than 60 years of history, the surgical exclusion of the LAA has been firmly established. Numerous approaches have been used for surgical LAA exclusion including surgical resections, suture ligation, cutting and non-cutting staples, and surgical clips. Additionally, a percutaneous epicardial LAA ligation approach has been developed. A discussion of the various epicardial LAA exclusion approaches and their efficacy will be discussed, along with the salient beneficial affects on LAA thrombus formation, LAA electrical isolation and neuroendocrine homeostasis.
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Affiliation(s)
- Randall J Lee
- Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Avenue, Box 1354, San Francisco, CA 94143, USA.
| | - Thorsten Hanke
- Department of Cardiovascular Surgery, ASKLEPIOS Klinikum Harburg, Abteilung Herzchirurgie, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany
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Nentwich K, Ene E, Halbfass P, Berkowitz A, Sonne K, Kerber S, Lee R, Deneke T. Concomitant epicardial left atrial appendage ligation and left atrial ablation of atrial fibrillation: Safety, feasibility and outcome. Indian Pacing Electrophysiol J 2021; 21:75-79. [PMID: 33460777 PMCID: PMC7952894 DOI: 10.1016/j.ipej.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction We present initial results of patients undergoing a combined procedure of epicardial LAA ligation in addition to left atrial ablation for AF. Methods 9 patients were included for additional use of LARIAT as an individual treatment approach for AF. First an epicardial LAA ligation was performed, in the same procedure left atrial ablations consisting of PVI and additional substrate based modifying ablations were performed. Follow–up at 3 months and 12 months was performed. Results There was only 1 minor procedural complication (11%) involving epicardial bleeding and 2 late adverse events of pericardial tamponade and stroke. At the final follow-up (median 20 months) 7 patients were in stable sinus rhythm (78%) and 2 pts had reduced AF burden. Conclusion Concomitant epicardial LAA ligation and ablation is feasible in selected patients with a reasonable risk profile. More prospective data are required to validate the safety and efficacy.
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Affiliation(s)
- Karin Nentwich
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany.
| | - Elena Ene
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
| | - Philipp Halbfass
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
| | - Arthur Berkowitz
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
| | - Kai Sonne
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
| | - Sebastian Kerber
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
| | - Randall Lee
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, 500 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Thomas Deneke
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
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Abstract
PURPOSE The left atrial appendage (LAA) is believed to be a source for thrombus formation and an ancillary structure involved in the initiation and maintenance of atrial fibrillation (AF). LAA ligation has been proposed as adjunctive therapy for the treatment of AF. This study will determine the feasibility of a percutaneous epicardial approach for LAA ligation. METHODS The pericardium of 5 dogs was accessed via percutaneous subxyphoid approach. A 20F epicardial cannula was inserted into the pericardial space and contrast-injected to visualize the LAA. Under fluoroscopic guidance, a suction cup catheter was inserted and attached to the LAA. A 12F snare device was inserted over the vacuum cup to ligate the LAA. The closure of the LAA was verified with LA angiography, in the first 2 dogs, and ICE in all 5 animals. All animals were sacrificed for post hoc assessment of LAA closure. RESULTS All 5 dogs underwent successful epicardial suture ligation of the LAA. In the first 2 dogs, LA angiography demonstrated complete closure of the LAA. All dogs underwent gross examination of the LAA. Post hoc assessment was notable for a small well-circumscribed hematoma on the LAA, consistent with point of suction cup attachment, as well as complete closure of the entire LAA. No laceration or perforation was noted on the LAA. CONCLUSIONS Exclusion of the LAA via a novel percutaneous epicardial-only approach was successful without complications. This demonstrates the feasibility of this technique in an animal model, and may provide an effective approach for epicardial-only LAA exclusion in humans.
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Affiliation(s)
- José M Sanchez
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Adam Lee
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantation, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Randall J Lee
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, CA, USA.
- , San Francisco, USA.
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Ellis CR, Badhwar N, Tschopp D, Danter M, Jackson GG, Kerendi F, Walters T, Fang Q, Deuse T, Beygui R, Lee RJ. Subxiphoid Hybrid Epicardial-Endocardial Atrial Fibrillation Ablation and LAA Ligation: Initial Sub-X Hybrid MAZE Registry Results. JACC Clin Electrophysiol 2020; 6:1603-15. [PMID: 33334437 DOI: 10.1016/j.jacep.2020.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and efficacy of a new subxiphoid hybrid epicardial-endocardial atrial fibrillation (AF) ablation and left atrial appendage (LAA) ligation approach for the treatment of persistent AF. BACKGROUND Surgical hybrid ablation procedures have shown promise for maintaining sinus rhythm versus catheter ablation but are associated with increased periprocedural adverse events. METHODS Patients with symptomatic persistent AF (n = 33, mean age 64 ± 9 years, 25 men) who had antiarrhythmic drug therapy or prior catheter ablation was unsuccessful were referred for hybrid epicardial-endocardial AF ablation and LAA exclusion. LAA closure was confirmed by transesophageal echocardiographic Doppler flow and/or computed tomographic angiography 1 to 3 months post-ligation. The incidence of atrial tachycardia or AF recurrence, LAA closure, thromboembolic events, and post-operative complications were assessed. RESULTS All 33 patients underwent successful LAA ligation with epicardial ablation of the posterior left atrial wall, as well as endocardial pulmonary vein isolation and cavotricuspid isthmus ablation. Freedom from atrial tachycardia or AF was 91% (20 of 22 patients) at 6 months, 90% (18 of 20 patients) at 12 months, 92% (11 of 12 patients) at 18 months, and 92% (11 of 12) at 24 months. There were no acute periprocedural complications (<7 days). Thirty-day adverse events included 2 patients with pericardial effusion requiring pericardiocentesis and 1 incisional hernia repair. There were no long-term complications, strokes, or deaths. LAA ligation was complete in 27 of 33 subjects (82%), with 6 subjects having leaks of <5 mm. CONCLUSIONS Subxiphoid hybrid epicardial-endocardial ablation with LAA ligation is feasible, safe, and effective. Future prospective studies are needed to validate these initial findings.
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
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Jerud ES, Gray WA. Gradually closing the loop. Catheter Cardiovasc Interv 2019; 94:843-844. [DOI: 10.1002/ccd.28570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Elliot S. Jerud
- Department of CardiologyLankenau Heart Institute Wynnewood Pennsylvania
| | - William A. Gray
- Interventional Cardiology, Lankenau Heart Institute Wynnewood Pennsylvania
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Parikh V, Bartus K, Litwinowicz R, Turagam MK, Sadowski J, Kapelak B, Bartus M, Podolec J, Brzezinski M, Musat D, Rasekh A, Mittal S, Cheng J, Badhwar N, Lee R, Lakkireddy D. Long‐term clinical outcomes from real‐world experience of left atrial appendage exclusion with LARIAT device. J Cardiovasc Electrophysiol 2019; 30:2849-2857. [DOI: 10.1111/jce.14229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/05/2019] [Accepted: 10/06/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Valay Parikh
- Department of ElectrophysiologyBaptist Health System San Antonio Texas
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, John Paul II HospitalJagiellonian University Krakow Poland
| | - Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, John Paul II HospitalJagiellonian University Krakow Poland
| | - Mohit K. Turagam
- Section of ElectrophysiologyIcahn School of Medicine at Mount Sinai New York
| | - Jerzy Sadowski
- Department of Cardiovascular Surgery and Transplantology, John Paul II HospitalJagiellonian University Krakow Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, John Paul II HospitalJagiellonian University Krakow Poland
| | | | - Jakub Podolec
- Department of Cardiovascular Surgery and Transplantology, John Paul II HospitalJagiellonian University Krakow Poland
| | | | - Dan Musat
- Section of ElectrophysiologyValley Health System Ridgewood New Jersey
| | - Abdi Rasekh
- Section of ElectrophysiologyTexas Heart Institute Houston Texas
| | - Suneet Mittal
- Section of ElectrophysiologyValley Health System Ridgewood New Jersey
| | - Jie Cheng
- Section of Electrophysiology, Baylor Medical CenterUniversity of Texas Houston Texas
| | - Nitish Badhwar
- Department of Medicine, Division of Cardiac ElectrophysiologyUniversity of California San Francisco San Francisco California
| | - Randall Lee
- Department of Medicine, Division of Cardiac ElectrophysiologyUniversity of California San Francisco San Francisco California
- Cardiovascular Research Institute, Institute for Regeneration MedicineUniversity of California San Francisco San Francisco California
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Nishimura M, Lupercio-lopez F, Hsu JC. Left Atrial Appendage Electrical Isolation as a Target in Atrial Fibrillation. JACC Clin Electrophysiol 2019; 5:407-16. [DOI: 10.1016/j.jacep.2019.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 11/21/2022]
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 10/27/2022]
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Abstract
The thrombus formed within the LAA is responsible for the vast (about 90%) majority of strokes. Anticoagulation, although effective therapy for stroke prevention is not feasible in a significant minority of patients due to various reasons. Two percutaenous LAA exclusion techniques have been developed in an effort to decrease risk for stroke: endocardial closure/plugging of the LAA (Watchman, Amplatzer devices) and epicardial LAA ligation (LARIAT). The aim of this study is to review the trial data to date for the LARIAT device. The LARIAT suture has been used in more than 4500 patients with high success of LAA complete closure (92-100%), mostly in the patients unable to take anticoagulation and in a small minority as antiarrhythmic option. The LARIAT technique has evolved with a change in pericardial access method that resulted in dramatic improvement of safety. LAA closure performance with LARIAT system seems to be similar to Watchman device, with small leaks during follow-up in 6-24% of the cases, which do not to correlate with thrombo-embolic events. LAA has been proven to play an important triggering role in patients with persistent atrial fibrillation. Small studies had shown that LAA ligation with LARIAT could terminate persistent atrial fibrillation and possible improve ablation success. Ongoing aMAZE randomized trial is studying if LAA ligaiton using LARIAT suture leads to improved atrial fibrillation ablation success. Available data suggests that LAA closure using LARIAT epicardial suture is a good alternative for stroke risk reduction in patients who are unable to be on anticoagulation therapy. LARIAT system might improve success of AF ablation for patients with persistent and long persistent AF, pending the results of the ongoing aMAZE trial.
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Affiliation(s)
- Dan Musat
- Valley Health System of NY and NJ, Paramus, NJ
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Sanchez JM, Al-Dosari G, Chu S, Beygui R, Deuse T, Badhwar N, Lee RJ. Hybrid and surgical procedures for the treatment of persistent and longstanding persistent atrial fibrillation. Expert Rev Cardiovasc Ther 2018; 16:91-97. [PMID: 29327638 DOI: 10.1080/14779072.2018.1425140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia. The incidence of AF increases with age and is associated with increased stroke, heart failure and mortality. Persistent and long standing persistent AF is difficult to treat and often refractory to medical therapy and catheter ablation. Areas covered: This article reviews the historical development of the surgical Cox-MAZE procedure and current hybrid and minimally invasive surgical approaches for the treatment of persistent and long standing persistent AF. The role of concomitant pulmonary vein isolation and left atrial appendage (LAA) exclusion will also be reviewed. Expert commentary: An ablation pattern emulating the Cox-Maze surgical procedure is commonly needed to obtain maintenance of sinus rhythm in patients with persistent and long standing persistent atrial fibrillation. Minimally invasive bilateral thorascopic surgical procedures can achieve a similar Cox-Maze lesion set, but are associated with increased adverse events compared to catheter ablation. Future prospective randomized studies are required to confirm whether the recently developed hybrid subxyphoid epicardial/endocardial procedure and percutaneous LAA ligation and catheter ablation are indeed as effective as surgical options with less adverse events.
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Affiliation(s)
- Jose M Sanchez
- a Division of Cardiology, Section of Cardiac Electrophysiology, Department of Medicine , University of California , San Francisco , CA , USA
| | - Ghannam Al-Dosari
- b Cardiovascular Surgery Division, Department of Surgery , University of Texas , Galvaston , TX , USA
| | - Sherman Chu
- a Division of Cardiology, Section of Cardiac Electrophysiology, Department of Medicine , University of California , San Francisco , CA , USA
| | - Ramin Beygui
- c Cardiovascular Surgery Division, Department of Surgery , University of California , San Francisco , CA , USA
| | - Tobias Deuse
- c Cardiovascular Surgery Division, Department of Surgery , University of California , San Francisco , CA , USA
| | - Nitish Badhwar
- a Division of Cardiology, Section of Cardiac Electrophysiology, Department of Medicine , University of California , San Francisco , CA , USA
| | - Randall J Lee
- a Division of Cardiology, Section of Cardiac Electrophysiology, Department of Medicine , University of California , San Francisco , CA , USA
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Friedman DJ, Black-Maier EW, Barnett AS, Pokorney SD, Al-Khatib SM, Jackson KP, Bahnson TD, Ellis CR, Atwater BD, Lewis RK, Piccini JP. Left Atrial Appendage Electrical Isolation for Treatment of Recurrent Atrial Fibrillation: A Meta-Analysis. JACC Clin Electrophysiol 2018; 4:112-20. [PMID: 29600775 DOI: 10.1016/j.jacep.2017.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Weber H, Sagerer-Gerhardt M, Heinze A. Laser catheter ablation of long- lasting persistent atrial fibrillation: Longterm results. J Atr Fibrillation 2017; 10:1588. [PMID: 29250231 DOI: 10.4022/jafib.1588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/15/2017] [Accepted: 08/20/2017] [Indexed: 11/10/2022]
Abstract
Catheter ablation of atrial fibrillation (AF) is a current therapeutic option but its efficacy for the treatment of long-lasting persistent AF (l-lpAF) remains suboptimal. We tested the laser method as an alternative for catheter ablation of l-lpAF by using an open-irrigated electrode laser mapping and ablation (ELMA) catheter. Laser ablation was attempted in 48 patients aged 50-81 years (69 ± 7.6 y, female = 28) with drug resistant (3.5 trials) l-lpAF (≥12 months). All of the patients had comorbidities: congestive heart failure NYHA II-III (100%), hypertension 29 (60%), coronary artery disease 19 (40%), and heart valve defect 17 (35%). None of the patients had diabetes or obstructive sleep apnea. All were in AF at the beginning of the procedure. Continuous wave (cw) 1064nm Nd:YAG laser applications at 15W/10-20s (14-26/patient) were applied via the ELMA catheter until local electrical activity displayed on the monitor in the bipolar focused local electrograms (LEG) recorded via the pin electrodes from the tip of the catheter was abolished permanently and sinus rhythm was achieved. Online monitoring of electrical potential amplitudes in the focused LEG recorded via the pin-electrodes of the ELMA catheter allowed for validation of ablation success. Procedure duration ranged from 82-175 min (118 ± 72 min), number of lesions were14-26 (19 ± 4) per patient and X-ray exposure times ranged from 15-82 min (23.2 ± 12 min). Interventions were without complications. After the ablation procedure all the patients were in sinus rhythm, off medication, however, 12 (25%) needed a repeat study for various arrhythmias. During followup of 9 months to 29.3 years (8.2 ± 6.5 years) patients' quality of life improved significantly and during final follow-up control all except two were off medication still in sinus rhythm (lifelong success rate = 96%). As compared to other catheter ablation methods the laser method is an intriguing alternative for catheter ablation of l-lpAF.
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Affiliation(s)
- Helmut Weber
- CCEP-Center Taufkirchen, Section Research Development Education, Taufkirchen, D- 82024 Taufkirchen, Germany.,Laser and Applied Technologies Center, Hospital Harlaching, Teaching Hospital of the LMUniversity of Munich, Munich, D-81545; Germany
| | - Michaela Sagerer-Gerhardt
- CCEP-Center Taufkirchen, Section Research Development Education, Taufkirchen, D- 82024 Taufkirchen, Germany.,Department of Anesthesiology, Hospital Neuperlach, Teaching Hospital of the LM-University of Munich, Munich, D-81737, Germany
| | - Armin Heinze
- CCEP-Center Taufkirchen, Section Research Development Education, Taufkirchen, D- 82024 Taufkirchen, Germany.,Laser and Applied Technologies Center, Hospital Harlaching, Teaching Hospital of the LMUniversity of Munich, Munich, D-81545; Germany
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Turagam M, Atkins D, Earnest M, Lee R, Nath J, Ferrell R, Bartus K, Badhwar N, Rasekh A, Cheng J, Di Biase L, Natale A, Wilber D, Lakkireddy D. Anatomical and electrical remodeling with incomplete left atrial appendage ligation: Results from the LAALA-AF registry. J Cardiovasc Electrophysiol 2017; 28:1433-1442. [DOI: 10.1111/jce.13343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mohit Turagam
- Division of Cardiovascular Medicine; University of Missouri Hospital and Clinics; Columbia MO USA
| | - Donita Atkins
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Matthew Earnest
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Randall Lee
- Section of Electrophysiology; UCSF Medical Center; San Francisco CA USA
| | - Jayant Nath
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Ryan Ferrell
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | | | - Nitish Badhwar
- Section of Electrophysiology; UCSF Medical Center; San Francisco CA USA
| | - Abdi Rasekh
- Baylor St. Luke's Medical Center; Houston TX USA
| | - Jie Cheng
- Texas Heart Institute; Houston TX USA
| | - Luigi Di Biase
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | - Andrea Natale
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | - David Wilber
- Division of Cardiovascular Medicine; Loyola University Medical Center; Chicago IL USA
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
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