Table 1

Controlled Studies Comparing LAAEI vs. No LAAEI for Maintenance of SR

First AuthorYearLAAEI (n)Control (n)Study DesignStudy DescriptionArrhythmia Follow-Up ProtocolArrhythmia EndpointMean Follow-Up (Months)
Di Biase (8)201016743Retrospective observationalPatients with LAA triggers during redo AF ablation managed with no ablation, LAAEI, or focal ablationHolter (48 h or 7 d) was obtained at 3, 6, 9, 13, and 15 months after ablation. Pts had event recorder for 5 months and had periodic asymptomatic transmissions per protocolAT/AF >32 s after 2-month blanking period12
Lee (10)2014119119Retrospective observational study with propensity matchingMitral valve surgery with cryomaze ± LAA excision at the surgeon’s discretionECG at 1, 3, 6, 12, 24, and 36 months. Holter used for asymptomatic patients, but use was not standardizedAF/AT after 3-month blanking period62
Lakkireddy (11)20156969Prospective observational with matched control subjectsProspective arm underwent LARIAT LAA occlusion followed by AF ablation during a separate procedure2-month event monitor beginning 2 weeks post procedure, 7-day monitor at 6- and 12-month visits, or additionally as clinically indicated. Device interrogation (when applicable) at 2-, 6-, and 12-month clinic appointmentsAT/AF >30 s after 2-month blanking12
Di Biase (12)20168588Randomized trialLAAEI vs. no LAAEI at the time of AF ablationHolter (48 h or 7 d) at 3, 6, 9, 12, and 15 months post ablation with event recorder for symptomatic evens and periodic asymptomatic transmissionsAT/AF >30 s after 12-week blanking period24
Panikker (13)20162040Prospective observational with matched control subjectsLAAEI with WATCHMAN occlusion at the time of AF ablation compared to AF ablation alone7-d continuous ECG monitoring at 3, 6, 9, and 12 monthsAT/AF >30 s after 3-month blanking period12
Park (14)20161824Retrospective observationalStepwise approach to AF ablation, with reporting of those with and without LAAEI at the conclusion of the procedureHolter monitoring (48 h) at 3, 6, 9, and 12 months after ablation>30 s AT/AF after 3-month blanking period21
Romanov (15)20168888Randomized trialSurgical AF ablation (PV isolation, box lesion, ganglionated plexi ablation) ± LAA excisionHolter at 3, 6, 9, 12, and 18 months with implantable monitors in ≈80%>30 s recurrent atrial arrhythmia after 3-month blanking period18

Value are n.

AF = atrial fibrillation; AT = atrial tachycardia; LAAEI = left atrial appendage electrical isolation; Pts = patients; PV = pulmonary vein; SR = sinus rhythm.

  • Study included a third arm with focal ablation of left atrial appendage (LAA) triggers (i.e., without complete isolation) that was not included in the current study.

  • Minimum arrhythmia duration was not specified.

  • Study included a third arm with delayed (but ongoing) LAA conduction (i.e., without complete isolation) that was not included in the current study.