Left Atrial Appendage Isolation for Stable Sinus Rhythm

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LAA isolation was achieved after a mean of 2 procedures.
LAA isolation was achieved after a mean of 2 procedures.

Electrical isolation of the left atrial appendage (LAA) helped promote stable sinus rhythm in patients with paroxysmal and short persistent atrial fibrillation (AF), according to research presented at the Heart Rhythm Society's 38th Annual Scientific Sessions, May 10-13, 2017, in Chicago, Illinois.

Although pulmonary vein isolation is an effective treatment strategy for paroxysmal AF and short persistent AF, ectopics from the LAA can trigger AF. Therefore, investigators sought to assess long-term follow-up and incidence of embolic stroke and LAA thrombus formation after LAA isolation in 71 patients. 

Pulmonary vein isolation, left atrial isthmus line, anterior line, complex atrial fractionated potentials, and roof line were among the ablation strategies used. LAA isolation was achieved after a mean of 2.0±1.0 procedures.

A total of 30% of patients (n=21) remained in stable sinus rhythm after a mean follow-up of 63±30 months. However, after 21±20 months from the initial procedure, a further catheter ablation procedure was performed in 72% of patients (n=51).

About half the patients (46%) remained in stable sinus rhythm after a mean of 1.5±1.2 procedures and 46±20 months of follow-up.

Embolic stroke occurred in 18% of patients (n=13) and LAA thrombus formation was discovered in 17% of patients (n=12) on oral anticoagulation.

“[A] high incidence of embolic stroke and LAA thrombus formation was observed despite sufficient [oral anticoagulation] therapy,” the researchers wrote. “Therefore, LAA isolation should be taken into consideration due to moderate benefit and potential risk of embolic events in clinical practice.”

Reference

Heeger CH, Rillig A, Tilz RR, et al. Long-term outcome and incidence of embolic stroke and left atrial appendage thrombus formation after electrical isolation of the left atrial appendage for the treatment of atrial tachyarrhythmias. Presented at: Heart Rhythm Society's 38th Annual Scientific Sessions. May 10-13, 2017; Chicago, Illinois. 

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