Author + information
- Received January 26, 2015
- Revision received April 13, 2015
- Accepted April 16, 2015
- Published online June 1, 2015.
- Dhanunjaya Lakkireddy, MD∗∗ (, )
- Arun Sridhar Mahankali, MD∗,
- Arun Kanmanthareddy, MD∗,
- Randall Lee, MD†,
- Nitish Badhwar, MD†,
- Krzysztof Bartus, MD, PhD‡,
- Donita Atkins, BSN∗,
- Sudharani Bommana, MPhil∗,
- Jie Cheng, MD, PhD§,
- Abdi Rasekh, MD§,
- Luigi Di Biase, MD, PhD‖,
- Andrea Natale, MD‖,
- Jayant Nath, MD∗,
- Ryan Ferrell, MD∗,
- Matthew Earnest, MD∗ and
- Yeruva Madhu Reddy, MD∗
- ∗Section of Cardiology, University of Kansas Hospital and Medical Center, Kansas City, Kansas
- †Section of Cardiology, University of California at San Francisco, San Francisco, California
- ‡Section of Cardiology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
- §Section of Cardiology, Texas Heart Institute, Houston, Texas
- ‖Section of Cardiology, Texas Cardiac Arrhythmia Institute, Austin, Texas
- ↵∗Reprint requests and correspondence:
Dr. Dhanunjaya Lakkireddy, Center for Excellence in Atrial Fibrillation/Complex Arrhythmia Management, Bloch Heart Rhythm Center, University of Kansas Hospital, 3901 Rainbow Boulevard, MS 4023, Kansas City, Kansas 66160-7200.
Objectives This study was intended to evaluate the impact of adding the left atrial appendage (LAA) closure system (LARIAT) procedure to conventional atrial fibrillation (AF) ablation in patients with persistent AF.
Background Percutaneous endoepicardial LARIAT may result in both mechanical and electrical exclusion of the LAA and aid in improving the outcomes of catheter ablation by eradicating the LAA triggers and altering the substrate.
Methods We performed a prospective observational study of patients with persistent AF referred for AF ablation. Patients underwent LAA ligation with LARIAT procedure before undergoing AF ablation (LARIAT group). Age- and sex-matched persistent AF patients undergoing AF ablation during the same time frame were included in the control group (ablation-only group).
Results A total of 138 patients were included in the study, with 69 patients in the LARIAT group. The mean age of the population was 67 ± 10 years, with 96 (70%) men. Left atrial (LA) size, CHADS2, CHADSVasc, and HAS-BLED scores were higher in the LARIAT group when compared with the ablation-only group. There were no differences in the type of lesions during AF ablation between the groups. The primary outcome of freedom from AF at 1 year off antiarrhythmic therapy after 1 ablation procedure was higher in the LARIAT group (45 [65%] vs. 27 [39%]; p = 0.002). More patients in the ablation-only group underwent repeat ablation because of AF recurrence (11 [16%] vs. 23 [33%]; p = 0.018).
Conclusions In patients with persistent AF, addition of LAA ligation with the LARIAT device to conventional ablation appears to improve the success rate of AF ablation.
Dr. Lakkireddy has received a research grant and a modest speakers honorarium from SentreHEART. Dr. Lee is a consultant for and has equity in SentreHEART. Dr. Bartus is a consultant for SentreHEART. Dr. Di Biase is a consultant for Biosense Webster, Boston Scientific, and St. Jude Medical; and has received speaker honoraria/travel fees from Medtronic, AtriCure, EPiEP, and Biotronik. Dr. Natale has received speaker honoraria from Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik, and Medtronic; and is a consultant for Biosense Webster, St. Jude Medical, and Janssen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 26, 2015.
- Revision received April 13, 2015.
- Accepted April 16, 2015.
- American College of Cardiology Foundation