Author + information
- Received June 24, 2019
- Revision received August 13, 2019
- Accepted August 14, 2019
- Published online January 20, 2020.
- Mohamed Al Rawahi, MDa,∗,
- Jackson J. Liang, DOa,b,∗,
- Suraj Kapa, MDc,
- Aung Lin, MDa,
- Yasuhiro Shirai, MDa,
- Ling Kuo, MDa,
- Erica S. Zado, PA-Ca,
- Matthew C. Hyman, MD, PhDa,
- Michael P. Riley, MD, PhDa,
- Saman Nazarian, MD, PhDa,
- Fermin C. Garcia, MDa,
- David Lin, MDa,
- Robert D. Schaller, DOa,
- Jeffery S. Arkles, MDa,
- David S. Frankel, MDa,
- Gregory E. Supple, MDa,
- Ramanan Kumareswaran, MDa,
- David J. Callans, MDa,
- Francis E. Marchlinski, MDa and
- Sanjay Dixit, MDa,∗ ()
- aElectrophysiology Section, Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bElectrophysiology Service, Cardiovascular Division, University of Michigan, Ann Arbor, Michigan
- cHeart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Sanjay Dixit, Electrophysiology Section, Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objective This study sought to investigate incidence of left atrial appendage (LAA) triggers of atrial fibrillation (AF) and/or organized atrial tachycardias (OAT) in patients undergoing AF ablation and to evaluate outcomes after ablation.
Background Although LAA isolation is being increasingly performed during AF ablation, the true incidence of LAA triggers for AF remains unclear.
Methods All patients with LAA triggers of AF and/or OAT during AF ablation from 2001 to 2017 were included. LAA triggers were defined as atrial premature depolarizations from the LAA, which initiated sustained AF and/or OAT.
Results Out of 7,129 patients undergoing AF ablation over 16 years, LAA triggers were observed in 21 (0.3%) subjects (age 60 ± 9 years; 57% males; 52% persistent AF). Twenty (95%) patients were undergoing repeat ablation. The LAA was the only nonpulmonary vein trigger in 3 patients; the remaining 18 patients had both LAA and other nonpulmonary vein triggers. LAA triggers were eliminated in all patients (focal ablation in 19 patients; LAA isolation in 2 patients). Twelve months after ablation, 47.6% remained free from recurrent arrhythmia. After overall follow-up of 5.0 ± 3.6 years (median: 3.7 years; interquartile range: 1.4 to 8.9 years), 38.1% were arrhythmia-free. All 3 patients with triggers limited to the LAA remained free of AF recurrence. One patient undergoing LAA isolation developed LAA thrombus during follow-up.
Conclusions The incidence of true LAA triggers is very low (0.3%). Most patients with LAA triggers have additional nonpulmonary vein triggers, and despite elimination of LAA triggers, long-term arrhythmia recurrence rates remain high. Potential risks of empiric LAA isolation during AF ablation (especially first-time AF ablation) may outweigh benefits.
↵∗ Drs. Al Rawahi and Liang contributed equally to this work and are joint first authors.
Dr. Kapa has received research support from Boston Scientific. Dr. Nazarian is a PI for grant from Biosense Webster, Siemens, and ImriCor; is a consultant to CardioSolv; and is a National PI for a study funded by Abbott. Dr. Kumareswaran is an education consultant for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 24, 2019.
- Revision received August 13, 2019.
- Accepted August 14, 2019.
- 2020 American College of Cardiology Foundation
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