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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Electrical Isolation Reduces Residual Patency After Device Closure in Patients With Persistent
Peng-Cheng Yao1, Mu Chen1, Qun-Shan Wang1
1Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China.
Insights
Left atrial appendage electrical isolation (LAAEI) effectively reduces left atrial appendage (LAA) patency after catheter ablation and LAA closure (LAAC) in atrial fibrillation (AF) patients. This strategy improves outcomes by minimizing stroke risk associated with LAA patency.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Left atrial appendage (LAA) patency post-catheter ablation and LAA closure (LAAC) is crucial for preventing post-procedure stroke in atrial fibrillation (AF) patients.
- The impact of LAA electrical isolation (LAAEI) on LAA patency following LAAC remains under investigation.
- This study addresses the unknown effect of LAAEI on LAA patency in AF patients undergoing combined procedures.
Purpose of the Study:
- To investigate the effect of LAA electrical isolation (LAAEI) on left atrial appendage (LAA) patency.
- To evaluate LAA patency after combined catheter ablation and LAA closure (LAAC) in patients with atrial fibrillation (AF).
Main Methods:
- A cohort of patients with persistent AF undergoing combined catheter ablation and LAAC was studied.
- LAA patency was assessed using cardiac computed tomographic angiography at 3 months post-procedure.
- Propensity score matching was employed to analyze clinical, echocardiographic, and procedural characteristics.
Main Results:
- In a matched cohort of 469 patients, LAAEI was associated with a significantly lower rate of LAA patency (34.9% vs. 49.6%; P=0.040).
- LAAEI demonstrated a protective effect against LAA patency (OR, 0.68).
- Maximum diameter of the LAA orifice was identified as another predictor of contrast leak into the LAA (OR, 1.04; P=0.046).
Conclusions:
- Left atrial appendage electrical isolation (LAAEI) is an effective strategy for reducing LAA patency.
- This finding is significant for patients with persistent AF undergoing combined catheter ablation and LAAC.
- LAAEI contributes to improved procedural outcomes by reducing LAA patency.
Background:
Left atrial appendage (LAA) patency after catheter ablation and LAA closure (LAAC) is a key determinant of postprocedure stroke. The effect of LAA electrical isolation (LAAEI) on LAA patency after LAAC in patients with atrial fibrillation (AF) remains unknown. Our objective was to explore the effect of LAAEI on LAA patency after catheter ablation and LAAC in patients with AF.
Methods:
Patients with persistent AF who underwent combined catheter ablation and LAAC were enrolled. LAA patency was detected by cardiac computed tomographic angiography at 3 months after the procedure.
Results:
A total of 686 patients with persistent AF with 3-month device surveillance by cardiac computed tomographic angiography were included initially. Propensity score matching analysis was conducted on the basis of clinical features, echocardiographic parameters and procedural characteristics, and 469 patients were matched, including 363 with non-LAAEI and 106 with LAAEI. Patients in matched groups showed 53.7% complete closure (no patency). Of the 46.3% of cases with LAA patency, visible peridevice leak was seen in 72.8%, and 27.2% had patency without visible peridevice leak. Compared with the non-LAAEI group, the LAAEI group had a lower rate of LAA patency (49.6% versus 34.9%; adjusted odds ratio, 0.69 [95% CI, 0.48-0.98]; P=0.040). LAAEI was protective against LAA patency with an odds ratio of 0.68, and the other predictor of contrast leak into the LAA was maximum diameter of LAA orifice (odds ratio, 1.04 [95% CI, 1.00-1.08]; P=0.046).
Conclusions:
LAAEI is an effective strategy for reducing LAA patency in patients with persistent AF undergoing combined catheter ablation and LAAC.
Registration:
URL: clinicaltrials.gov; Unique Identifier: NCT03788941.
