Nueva estrategia de aislamiento de la orejuela izquierda para la fibrilación auricular persistente que requiere...

The left atrial appendage (LAA) is a trigger for AF in nearly one-third of patients with persistent AF undergoing repeat ablation, and LAAI has been shown to improve arrhythmia outcomes. Prior studies of LAAI using an ostial approach without VOM resulted in variable rates of acute and durable LAAI and elevated risk of stroke.

To assess the feasibility and effect of left atrial appendage isolation (LAAI) using an anterior mitral line (AML) and posterior mitral line (PML), with adjunctive Vein of Marshall ethanol ablation (VOM), in patients with persistent atrial fibrillation (AF) undergoing repeat ablation.

We prospectively identified 23 patients undergoing repeat ablation for persistent AF in whom LAAI was intentionally performed via AML and PML +/- VOM from 2023-2024. Patients were systematically remapped at the time of left atrial appendage occlusion (LAAO) to assess LAAI durability. Arrhythmia-free survival was assessed using Kaplan-Meier analysis.

The mean age was 72, 74% of patients were male and 87% were white. VOM was successfully performed in 74% of cases and LAAI was achieved acutely in all. The rate of durable LAAI was 61% and the arrhythmia recurrence rate was 61% at 1 year, with AT occurring more frequently than AF. There was no evidence of acute thrombus and no strokes or TIAs occurred.

LAAI using a linear approach of AML and PML with VOM is feasible and reproducible, and results in a low rate of arrhythmia recurrences, most of which are self-limited.