Left Atrial Appendage Electrical Isolation as a Target in Atrial Fibrillation

Although the benefit of catheter ablation of the pulmonary veins is well established in paroxysmal atrial fibrillation (AF), the optimal ablation strategy for persistent AF is yet to be determined. Pulmonary vein isolation in persistent AF often results in AF recurrence and the success rate may be low even after multiple procedures. Recurrent AF risk may be secondary to non-pulmonary vein triggers, and adjunctive therapies to better control persistent AF are under investigation. The left atrial appendage (LAA) is a complex structure with distinct physiological and electrical properties, and multiple studies have implicated the LAA as a potential contributor to persistence of AF. Therapies targeting the LAA for electrical isolation have demonstrated potential efficacy in freedom from AF. The overarching concept of this therapy is to isolate the atria electrically from the LAA via catheter ablation, surgical excision or ligation, or percutaneous ligation. LAA electrical isolation has already demonstrated benefit in reducing AF recurrence and AF burden. LAA electrical isolation has the potential to form a foundational piece in the optimal rhythm control management of AF and therefore warrants further study and is the focus of this review.