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Updated: Mar 21, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Effect of left atrial appendage excision on procedure outcome in patients with persistent atrial fibrillation
Alexander Romanov1, Evgeny Pokushalov1, Dmitry Elesin1
1State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Insights
Adding left atrial appendage (LAA) excision to pulmonary vein isolation (PVI) and box lesion ablation for persistent atrial fibrillation (PersAF) did not improve success rates. This surgical approach showed no significant benefit over PVI and box lesion alone.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Catheter ablation for persistent atrial fibrillation (PersAF) has lower success rates compared to paroxysmal atrial fibrillation.
- Studies suggest combining pulmonary vein isolation (PVI) with left atrial appendage (LAA) isolation may improve outcomes for PersAF.
Purpose of the Study:
- To compare the efficacy and safety of two surgical ablation techniques for PersAF using video-assisted thoracoscopy.
- The techniques compared were PVI + box lesion versus PVI + box lesion + LAA excision.
Main Methods:
- A randomized trial involving 176 patients with PersAF undergoing video-assisted thoracoscopic surgical ablation.
- Patients were assigned to either PVI + box lesion (88 patients) or PVI + box lesion + LAA excision (88 patients).
- The primary endpoint was freedom from atrial arrhythmia lasting over 30 seconds after a single procedure without antiarrhythmic drugs (AAD).
Main Results:
- After 18 months, freedom from recurrent atrial fibrillation was similar between groups (70.9% vs 73.6%, P = .73).
- Freedom from any atrial arrhythmia, with or without AAD, was also not significantly different (70.9% vs 74.7%).
- No significant differences in adverse events, including stroke and pneumothorax, were observed between the two groups.
Conclusions:
- Left atrial appendage excision in addition to PVI and box lesion during surgical ablation for PersAF did not reduce the rate of recurrent atrial fibrillation.
- The addition of LAA excision to standard PVI and box lesion surgical ablation does not appear to offer additional benefit for patients with persistent atrial fibrillation.
Background:
Catheter ablation is less successful for treatment of persistent atrial fibrillation (PersAF) than for paroxysmal atrial fibrillation. Some studies suggest that left atrial appendage (LAA) isolation in addition to pulmonary vein isolation (PVI) is required to maximize the benefits for PersAF after ablation.
Objective:
The purpose of this study was to compare the efficacy and safety of 2 surgical ablation approaches for PersAF via video-assisted thoracoscopy: PVI + box lesion and PVI + box lesion + LAA excision.
Methods:
We randomly assigned 176 patients with PersAF to video-assisted thoracoscopic surgical ablation with PVI + box lesion (88 patients) or PVI + box lesion + LAA excision (88 patients). The primary endpoint was freedom from any documented atrial arrhythmia lasting >30 seconds after a single ablation procedure without antiarrhythmic drug (AAD).
Results:
After 18 months of follow-up, 61 of 86 patients (70.9%) assigned to PVI + box lesion were free from recurrent atrial fibrillation compared to 64 of 87 patients (73.6%) assigned to PVI + box lesion + LAA excision after a single ablation procedure without AAD (P = .73). Freedom from any atrial arrhythmia after a single procedure with or without AAD was also nonsignificant (70.9% vs 74.7%, respectively). There were no significant differences between groups with regard to adverse events, including death, transient ischemic attack, stroke, pneumothorax, and hydrothorax.
Conclusion:
Among patients with PersAF, no reduction in the rate of recurrent atrial fibrillation was found when LAA excision was performed in addition to PVI and box lesion during surgical ablation.
