Does Left Atrial Appendage Amputation During Routine Cardiac Surgery Reduce Future Atrial Fibrillation and Stroke?

Dominguez, Helena; Madsen, Christoffer Valdorff; Westh, Oliver Nøhr Hjorth; Pallesen, Peter Appel; Carrranza, Christian Lildal; Irmukhamedov, Akhmadjon; Park-Hansen, Jesper

doi:10.1007/s11886-018-1033-4

Cited by 10 publications

(8 citation statements)

References 89 publications

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“…LAA exclusion or excision may be considered in conjunction with surgical ablation for AF and at the time of cardiac operations in AF patients for thromboembolic prevention (Class IIA, level C expert opinion by the surgical guidelines, whereas the AHA/ACC/HRS guidelines consider it a Class IIB, Level of evidence B‐nonrandomized data) and the European guidelines consider it a Class IIB, Level of Evidence C 61,62,76 . Despite the high prevalence of postoperative AF, there is not sufficient evidence to recommend routine left atrial exclusion during heart surgery 77 …”

Section: Stroke Prevention In Af‐sex Differences In Stroke Riskmentioning

confidence: 99%

“…61,62,76 Despite the high prevalence of postoperative AF, there is not sufficient evidence to recommend routine left atrial exclusion during heart surgery. 77 Surgical occlusion of the LAA (LAAO) includes excision or amputation, and exclusion (clip/stapler, suture ligation). Success rates vary according to surgical procedure with highest success with excision/amputation techniques.…”

Section: Percutaneous Laa Closure Devicesmentioning

confidence: 99%

See 1 more Smart Citation

Women and atrial fibrillation

Volgman

Benjamin

Curtis

et al. 2020

Cardiovasc electrophysiol

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Atrial fibrillation (AF) remains a growing problem in the United States and worldwide, imposing a high individual and health system burden, including increased resource consumption due to repeated hospitalizations, stroke, dementia, heart failure, and death. This comprehensive review summarizes the most recent data on sex‐related differences in risks associated with AF. Women with AF have increased risk of stroke and death compared to men, and possible reasons for this disparity are explored. Women also continue to have worse symptoms and quality of life, and poorer outcomes with stroke prevention, as well as with rate and rhythm control management strategies. Many current rhythm control treatment strategies for AF, including cardioversion and ablation, are used less frequently in women as compared to men, whereas women are more likely to be treated with rate control strategies or antiarrhythmic drugs. Sex differences should be considered in treating women with AF to improve outcomes and women and men should be offered the same interventions for AF. We need to improve the evidence base to understand if variation in utilization of rate and rhythm control management between men and women represents health inequities or appropriate clinical judgement.

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Section: Stroke Prevention In Af‐sex Differences In Stroke Riskmentioning

confidence: 99%

Section: Percutaneous Laa Closure Devicesmentioning

confidence: 99%

Women and atrial fibrillation

Volgman

Benjamin

Curtis

et al. 2020

Cardiovasc electrophysiol

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“…Although the traditional rationale of concomitant surgical LAA amputation was to prevent LAA thrombus formation and subsequent development of stroke, there is mounting interest as to whether or not this may also reduce the burden of AF [45]. However, at present, there is insufficient trial data to support this technique as the main purpose for amputation in routine clinical practice.…”

Section: Surgical Laa Amputationmentioning

confidence: 99%

Electrical Isolation of the Left Atrial Appendage - A New Frontier in the Treatment for Atrial Fibrillation

Kaba¹,

Ahmed²,

Momin³

2020

J Cardiovasc Dis Diagn

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Atrial fibrillation is not only the most common clinical arrhythmia, it is also one of the most challenging conditions to treat in day-today clinical practice. In particular, the persistent form of this condition is not easily amenable to traditional forms of therapy, whereas, the paroxysmal form is far more responsive to standard modes of treatment. In our relentless quest to find better solutions to overcome persistent atrial fibrillation, arguably the most promising of these currently appears to be electrical isolation of the left atrial appendage. Whilst surgical amputation of the left atrial appendage for stroke prevention has been practiced for more than half a century, only recently has attention gradually been shifting to electrical isolation of the left atrial appendage for the treatment of persistent atrial fibrillation. In this review article, we present compelling pieces of evidence for the use of this strategy, and the various ways in which it can be achieved.

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“… 1 , 2) For many years, intensive research into AF has provided deep insight into the subject while elucidating more knowledge gaps and inadequacies in the current therapeutic options. 3 – 6) Specifically, the advances in widely adapted catheter ablation technologies have not converted to significant gains in success rates over recent years. 7) It is however important to note that stroke is the most dreaded complication for each AF patient.…”

Section: Introductionmentioning

confidence: 99%

“…The left atrial appendage (LAA) is considered a major source of thromboembolic origin in AF patients. 3) However, some studies have shown that LAA contractile function contributes greatly to left atrial mechanical contraction. 8 – 10) Moreover, the LAA also plays an important role in body fluid regulation via the secretion of atrial natriuretic peptide (ANP).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Minimally Invasive Thoracoscopic Left Atrial Appendage Excision on Cardiac Dynamic and Endocrine Function

Zhang

Yang

et al. 2021

ATCS

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Purpose: Left atrial appendage (LAA) isolation is an effective surgical treatment for decreasing thromboembolic risk. We sought to evaluate the short-term effect of minimally invasive surgery with LAA excision on left atrial dynamic and endocrine function in atrial fibrillation (AF) patients. Methods: A total of 52 patients with paroxysmal AF undergoing minimally invasive surgery with LAA excision in Anzhen Hospital from October 2012 to June 2014 were enrolled in the study. The natriuretic peptide plasma level was determined by enzyme-linked immunosorbent assay (ELISA), and left atrial dynamic function was measured preprocedure by real-time three-dimensional echocardiography and postprocedure after 7 days and 3 months. Results: With the exception of six recurrences, 88.5% (46/52) of the patients were prospectively followed over 3 months in terms of their sinus rhythm postprocedure. No severe operative complications or embolism events occurred within those 3 months. Echocardiography showed a 3–6% decrease in left atrial volume postprocedure, and dynamic function was largely restored by 3 months. There was no significant change in natriuretic peptide levels, although a slight decrease was detected 7 days postprocedure, which gradually recovered by 3 months ( P = 0.350). Conclusions: There are no significant differences in left atrial dynamics and natriuretic peptide secretion in AF patients after minimally invasive surgery with LAA excision.

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Does Left Atrial Appendage Amputation During Routine Cardiac Surgery Reduce Future Atrial Fibrillation and Stroke?

Cited by 10 publications

References 89 publications

Women and atrial fibrillation

Women and atrial fibrillation

Electrical Isolation of the Left Atrial Appendage - A New Frontier in the Treatment for Atrial Fibrillation

The Effect of Minimally Invasive Thoracoscopic Left Atrial Appendage Excision on Cardiac Dynamic and Endocrine Function

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