Author + information
- Received March 13, 2017
- Revision received July 2, 2017
- Accepted July 20, 2017
- Published online January 15, 2018.
- Daniel J. Friedman, MDa,b,
- Eric W. Black-Maier, MDa,
- Adam S. Barnett, MDa,
- Sean D. Pokorney, MD, MBAa,b,
- Sana M. Al-Khatib, MD, MHSa,b,
- Kevin P. Jackson, MDa,
- Tristram D. Bahnson, MDa,b,
- Christopher R. Ellis, MDc,
- Brett D. Atwater, MDa,
- Robert K. Lewis, MD, PhDa and
- Jonathan P. Piccini, MD, MHSa,b,∗ ()
- aDuke Center for Atrial Fibrillation, Duke University Hospital, Durham, North Carolina
- bDuke Clinical Research Institute, Durham, North Carolina
- cVanderbilt University Medical Center, Nashville, Tennessee
- ↵∗Address for correspondence:
Dr. Jonathan P. Piccini, Electrophysiology Section, Duke Clinical Research Institute, 2400 Pratt Street, Durham, North Carolina 27705.
Objectives In this study, the authors sought to perform a meta-analysis of controlled studies assessing the relationship between left atrial appendage (LAA) electrical isolation (EI) and recurrent atrial fibrillation (AF).
Background LAA triggers could play an important role in AF and can be treated with complete EI of the LAA via surgical or percutaneous approaches.
Methods We conducted a meta-analysis of all controlled studies published as of November 21, 2016, assessing the relationship between left atrial appendage electrical isolation (LAAEI) and recurrent AF. The primary endpoint was atrial tachycardia (AT) or AF recurrence after the post-procedure blanking period. The association between LAAEI and AT/AF was estimated using random-effects modeling. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the DerSimonian and Laird method.
Results We identified 7 studies including 1,037 patients; LAAEI was performed in 566 patients (55%). LAAEI was associated with a significantly lower rate of AT/AF recurrence in the primary analysis (OR: 0.38; 95% CI: 0.16 to 0.90; p = 0.02). The association between LAAEI and recurrent AT/AF was strongest in a sensitivity analysis restricted to studies of percutaneous LAAEI (OR: 0.22; 95% CI: 0.11 to 0.46; p < 0.001; 5 studies, n = 623). LAAEI was not associated with thromboembolism (OR: 0.50; 95% CI: 0.18 to 1.39; p = 0.18; 5 studies, n = 767), although these studies either incorporated LAA occlusion (3 studies, n = 552 patients) or follow-up echocardiography to assess LAA function (2 studies, n = 215 patients) to inform antithrombotic strategies.
Conclusions LAAEI is associated with a significant reduction in recurrent AT/AF. Randomized trials are required to confirm the efficacy and long-term safety of LAAEI and to determine the optimal concomitant antithrombotic strategy.
Dr. Friedman is funded by the National Institutes of Health (T 32 training grant HL069749); has received educational grants from St. Jude Medical, Abbott, and Boston Scientific; and research grants from the National Cardiovascular Data Registry. Dr. Pokorney has received research grants from the U.S. Food and Drug Administration, Boston Scientific, Gilead, Bristol-Myers Squibb, and Janssen Pharmaceuticals; and advisory board/consulting support from Medtronic, Boston Scientific, and Bristol-Myers Squibb. Dr. Jackson has served as a consultant to Abbott, Medtronic, St. Jude Medical, and Merit Medical. Dr. Bahnson has received research grants from Medtronic and St. Jude Medical; and has served as a consultant to Boehringer Ingelheim, ChanRX, Sequel Pharma, and Sanofi-Aventis. Dr. Ellis has received research grants from AtriCure, Boston Scientific, and Medtronic; and has served as a consultant to SentreHEART, AtriCure, and Boston Scientific. Dr. Atwater has received research grants from St. Jude Medical and Boston Scientific; and has served as a consultant to Biosense Webster, Biotronik, Boston Scientific, St. Jude Medical, and Medtronic. Dr. Piccini has received research grants for clinical research from ARCA Biopharma, Boston Scientific, Gilead, Janssen Pharmaceuticals, and St. Jude Medical; and has served as a consultant to Allergan, Amgen, GlaxoSmithKline, Johnson & Johnson, Medtronic, and Spectranetics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received March 13, 2017.
- Revision received July 2, 2017.
- Accepted July 20, 2017.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.