Related Experiment Video
Updated: Apr 12, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage ligation in patients with atrial fibrillation leads to a decrease in atrial dispersion
Mitsuharu Kawamura1, Melvin M Scheinman1, Randall J Lee1
1Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, CA (M.K., M.M.S., R.J.L., N.B.).
Insights
Left atrial appendage (LAA) ligation in atrial fibrillation (AF) patients shortens P-wave duration and reduces P-wave dispersion, suggesting reverse electrical remodeling and potentially maintaining sinus rhythm.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- Left atrial appendage (LAA) exclusion is used in atrial fibrillation (AF) to prevent cardioembolic events.
- Left atrial electrical remodeling contributes to AF recurrence.
- The impact of LAA exclusion on P-wave characteristics and atrial remodeling is not well understood.
Purpose of the Study:
- To investigate the effect of LAA ligation on P-wave morphology in AF patients.
Main Methods:
- Evaluated P-wave duration, amplitude, PQ interval, and dispersion before and after LAA ligation in 15 AF patients.
- Patients were in sinus rhythm during the procedure.
Main Results:
- P-wave duration significantly decreased post-ligation (P<0.05).
- P-wave dispersion decreased significantly after 1-3 months (P=0.02).
- PQ interval shortened immediately post-ligation (P=0.01).
Conclusions:
- LAA exclusion leads to P-wave changes indicating reduced atrial mass and dispersion.
- These changes may represent reverse electrical atrial remodeling.
- LAA ligation might help maintain sinus rhythm in AF patients.
Background:
Left atrial appendage (LAA) exclusion has been performed in patients with atrial fibrillation (AF) to prevent thrombus formation and subsequent cardioembolic events. Left atrial electrical remodeling is a recognized factor in the recurrence of AF. The effects of LAA exclusion on P-wave characteristics and left atrial electrical remodeling have not been well described. The purpose of this study was to evaluate the effect of LAA ligation on P-wave morphology in patients with AF.
Methods And Results:
Fifteen patients who were in sinus rhythm during the LAA ligation procedure were included in the study. We evaluated the P-wave characteristics, including P-wave duration, P-wave amplitude, PQ interval, and P-wave dispersion, before and after ligation. Eleven patients had paroxysmal AF and 4 patients had persistent AF (12 male patients and 3 female patients). P-wave duration immediately after ligation was significantly shorter compared with baseline in all limb leads except lead aVR (P<0.05). P-wave amplitude immediately after ligation was significantly greater compared with baseline in inferior leads; however, P-wave amplitude after 1 to 3 months was significantly lower compared with immediately after ligation. PQ interval immediately after ligation was significantly shorter compared with baseline (P=0.01), and P-wave dispersion after 1 to 3 months was significantly shorter compared with baseline (P=0.02).
Conclusions:
LAA exclusion produces consistent P-wave changes consistent with decreased atrial mass and decreased atrial dispersion that may represent reverse electrical atrial remodeling. This is a potential mechanism to explain the role of LAA ligation in maintaining sinus rhythm in patients with AF.
Related Concept Videos
01:25Dysrhythmias VI: Management of Dysrhythmias
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias