Cryoballoon-Based Left Atrial Appendage Isolation and Closure in Patients with Atrial Fibrillation-The LALALAND Pilot...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrial fibrillation (AF) is the most common cardiac arrhythmia.
• Pulmonary vein isolation (PVI) is standard for AF treatment, but success rates are limited in persistent AF (PersAF).
• Left atrial appendage (LAA) is a potential target for ablation, with cryoballoon (CB) technology showing promise for durable PVI and LAA isolation (LAAI).

Purpose of the Study:

• To investigate the clinical impact of CB-based LAAI in addition to PVI for patients with symptomatic PersAF.
• To assess the durability of LAAI and PVI after CB ablation.
• To evaluate the safety and efficacy of combining CB-based LAAI with percutaneous LAA closure (LAAC).

Main Methods:

• Prospective, interventional, single-centre study enrolling 23 patients with symptomatic PersAF.
• Patients underwent PVI plus LAAI using the CB system.
• Percutaneous LAA closure (LAAC) was performed 2-3 months post-ablation, with LAAI durability assessed by invasive remapping prior to LAAC.

Main Results:

• 100% PVI success and 91% initial LAAI success were achieved with CB.
• LAA thrombus formation occurred in 26% of patients post-LAAI.
• Durable LAA isolation was achieved in 74% and durable PVI in 70% of patients.
• At 13-month follow-up, 65% maintained sinus rhythm, but LAA reconnection occurred in 13%, leading to recurrence.
• One stroke and one device thrombus occurred during follow-up post-LAAC.

Conclusions:

• CB-based LAAI combined with PVI may improve outcomes in PersAF but carries a significant risk of LAA thrombus formation.
• Early LAAC following LAAI appears promising for risk mitigation.
• Further evidence is required to establish optimal practices for this combined approach.