Author + information
- Received December 23, 2018
- Revision received February 25, 2019
- Accepted February 28, 2019
- Published online April 15, 2019.
- Marin Nishimura, MD,
- Florentino Lupercio-Lopez, MD and
- Jonathan C. Hsu, MD, MAS∗ ()
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
- ↵∗Address for correspondence:
Dr. Jonathan C. Hsu, Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, California 92037.
• Studies of patients with persistent AF have implicated the LAA as an important contributor to triggering and maintenance of AF in some patients.
• Electrical isolation of the LAA via catheter ablation, surgical excision or ligation, and percutaneous ligation have all demonstrated efficacy in reducing AF recurrence or AF burden.
• More data directly comparing success and safety of different LAAEI strategies is needed, and there are ongoing challenges with each of these methods, including the concern for increased thrombotic risk following LAAEI by catheter ablation.
• LAAEI has the potential to form a foundational piece in the optimal rhythm control management of persistent AF.
Although the benefit of catheter ablation of the pulmonary veins is well established in paroxysmal atrial fibrillation (AF), the optimal ablation strategy for persistent AF is yet to be determined. Pulmonary vein isolation in persistent AF often results in AF recurrence and the success rate may be low even after multiple procedures. Recurrent AF risk may be secondary to non–pulmonary vein triggers, and adjunctive therapies to better control persistent AF are under investigation. The left atrial appendage (LAA) is a complex structure with distinct physiological and electrical properties, and multiple studies have implicated the LAA as a potential contributor to persistence of AF. Therapies targeting the LAA for electrical isolation have demonstrated potential efficacy in freedom from AF. The overarching concept of this therapy is to isolate the atria electrically from the LAA via catheter ablation, surgical excision or ligation, or percutaneous ligation. LAA electrical isolation has already demonstrated benefit in reducing AF recurrence and AF burden. LAA electrical isolation has the potential to form a foundational piece in the optimal rhythm control management of AF and therefore warrants further study and is the focus of this review.
Dr. Hsu has received honoraria from Medtronic, St. Jude Medical, Boston Scientific, and Biotronik; and has received research grants from Biosense-Webster, Biotronik, and SentreHEART Inc. 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 December 23, 2018.
- Revision received February 25, 2019.
- Accepted February 28, 2019.
- 2019 American College of Cardiology Foundation
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