Author + information
- Received June 25, 2018
- Revision received September 18, 2018
- Accepted September 20, 2018
- Published online November 28, 2018.
- Thomas Fink, MDa,∗ (, )
- Michael Schlüter, PhDb,
- Christian-Hendrik Heeger, MDa,∗,
- Christine Lemeš, MDa,
- Tilman Maurer, MDa,
- Bruno Reissmann, MDa,
- Laura Rottner, MDa,
- Francesco Santoro, MDa,
- Roland Richard Tilz, MDa,∗,
- Hannes Alessandrini, MDa,
- Andreas Rillig, MDa,c,
- Shibu Mathew, MDa,
- Peter Wohlmuth, PhDb,
- Qizhi Fang, MDd,
- Randall Lee, MD, PhDd,
- Feifan Ouyang, MDa,
- Karl-Heinz Kuck, MDa and
- Andreas Metzner, MDa
- aDepartment of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- bAsklepios Proresearch, Hamburg, Germany
- cDepartment of Cardiology, Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Berlin, Germany
- dDivision of Cardiology and the Cardiovascular Research Institute, University of California, San Francisco, California
- ↵∗Address for correspondence
: Dr. Thomas Fink, Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany.
Objectives This study investigated the outcome of wide-area left atrial appendage isolation (WLAAI) and subsequent LAA ligation in patients with recurrent atrial arrhythmias after pulmonary vein isolation (PVI).
Background LAA isolation and ligation may improve rhythm control and prevent LAA thrombus formation in patients with atrial fibrillation who do not respond to PVI.
Methods Patients (n = 31, mean age: 69.7 ± 7.8 years, 18 men) with arrhythmia recurrence after established PVI undergoing WLAAI with subsequent LAA ligation (LARIAT+ device) were studied. The incidence of arrhythmia recurrence, intracardiac thrombus formation, thromboembolic events, as well as changes in P-wave duration and P-wave dispersion were assessed.
Results All 31 patients underwent successful WLAAI, and successful LAA ligation was performed in 27 patients (87%). Over a median follow-up of 498 (interquartile range: 159, 791) days, post-ligation arrhythmia recurrence was documented in 8 patients (26%). Kaplan-Meier estimate of 24-month arrhythmia-free survival after WLAAI/ligation was 69.7% (95% confidence interval: 53.9 to 90.1). Following WLAAI, LAA thrombus formation was seen in 11 patients (35.5%), but in no patient after LAA ligation. WLAAI/ligation significantly reduced P-wave duration (from 93 ± 20 ms to 72 ± 20 ms; p = 0.001) and P-wave dispersion (from 63 ± 37 ms to 38 ± 16 ms; p = 0.001).
Conclusions WLAAI and subsequent LAA ligation in PVI nonresponders led to an estimated freedom from arrhythmia recurrence in 70% of the patients at 24 months. LAA ligation successfully prevented recurrence of cardiac thrombus formation in patients with WLAAI. Significant decreases in P-wave duration and P-wave dispersion occurred with WLAAI/ligation, suggesting favorable electrical remodelling.
- arrhythmia recurrence
- atrial fibrillation
- catheter ablation
- epicardial left atrial appendage closure
- left atrial appendage isolation
↵∗ Current affiliation for Drs. Heeger and Tilz: Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany.
Drs. Fink and Heeger have received travel grants from SentreHeart. Dr. Tilz has received research grants from Medtronic and Biotronik; travel grants from Biosense Webster, Medtronic, Abbot, SentreHeart, and Daiichi Sankyo; Speakers Bureau/proctor honoraria from Biosense Webster, Medtronic, Abbot, SentreHeart, and Daiichi Sankyo; consults for Biosense Webster and Biotronik. Dr. Rillig has received travel grants from Biosense, Hansen Medical, EP Solutions, Medtronic, and St. Jude Medical; and lecture fees from St. Jude Medical, Medtronic, and Boehringer Ingelheim; and participated in the Boston Scientific EP fellowship. Dr. Mathew has received speaker’s honoraria and travel grants from Medtronic. Dr. Lee consults for and has equity in SentreHeart, Inc. and Apama, Inc. (Boston Scientific, Inc.). Dr. Kuck has received research grants and personal fees from St. Jude Medical, Medtronic, Biosense Webster, Boston Scientific, Abbott, and Edwards. Dr. Metzner received speaker’s honoraria and travel grants from Medtronic. AR received. 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 June 25, 2018.
- Revision received September 18, 2018.
- Accepted September 20, 2018.
- 2018 American College of Cardiology Foundation
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