Exclusion of electrical and mechanical function of the left atrial appendage in patients with persistent atrial fibrillation: differences in efficacy and safety between endocardial ablation vs epicardial LARIAT ligation (the EXCLUDE LAA study)

Parikh, Valay; Rasekh, Abdi; Mohanty, Sanghamitra; Yarlagadda, Bharath; Atkins, Donita; Bommana, Sudha; Turagam, Mohit K.; Jeffery, Courtney; Carroll, Heidi; Nydegger, Cheri; Jaeger, Misty; Dar, Tawseef; Cheng, Jie; Gopinnathanair, Rakesh; DiBiase, Luigi; Lee, Randal; Horton, Rodney; Lakkireddy, Dhanunjaya

doi:10.1007/s10840-019-00657-1

Cited by 7 publications

(8 citation statements)

References 18 publications

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“…A hybrid (endo-epi) approach using the LARIAT system achieves electrical isolation and LAA ligation utilizing an endo-epicardial suture delivery system ( 34 ). This novel technique has a high success rate of LAA isolation ( 35 ), but large long term stroke prevention data has not been published ( 36 , 37 ). Early concerns about procedural complications, predominantly related to bleeding ( 36 , 38 ) have been reduced with further refinement of the technique ( 37 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

“…A thoracoscopic approach using the AtriClip device has been shown to achieve LAAi and LAA exclusion simultaneously with minimal complications ( 44 ). While it has been shown to be an effective strategy for LAA exclusion, large long-term data regarding IS/TIA prevention and comparison with established LAA occlusion strategies is lacking ( 35 ). Randomized studies will be needed to explore the efficacy, safety, and feasibility of such a strategy.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Stroke Risk in Patients Undergoing Left Atrial Appendage Ablation With and Without Complete Isolation

Dhorepatil

Lang

et al. 2021

Front. Cardiovasc. Med.

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Background: Catheter ablation (CA) for atrial fibrillation (AF), may require ablation beyond the pulmonary veins. Prior data suggest that additional LA ablation, particularly left atrial appendage (LAA) ablation, may alter atrial function leading to increased risk of ischemic stroke or transient ischemic attack (IS/TIA). We sought to study the long-term risk of IS/TIA in patients receiving ablation at the LAA compared to those receiving PVI alone and those receiving PVI with additional non-LAA locations.Methods: 350 patients who underwent CA for AF from 2008 to 2018 were included in the study. Locations of ablation in LA evaluated were the posterior wall, anterior wall, inferior wall, inter-atrial septum, lateral wall and the left atrial appendage (LAA). Patients undergoing LAA ablation were further divided as complete isolation (LAAi) and without complete isolation (LAAa).Results: Mean follow up of 4.8 years. In entire cohort, risk of IS/TIA was 1.62/100 patient-years (pys). The risk was highest in patients with LAAi (3.81/100 pys), followed by ablation LAAa (3.74/100 pys). Amongst all LA locations, only LAAi (HR 3.32, p = 0.03) and LAAa (HR 3.18, p = 0.02) were statistically significant predictors of IS/TIA after adjusting for OAC (Oral anticoagulant) use and baseline CHA2DS2VASc score.Conclusions: During long term follow-up, only ablation at the left atrial appendage with and without complete isolation was independently associated with an increased risk of IS/TIA in patients undergoing CA for AF. Potential strategies to reduce stroke risk, such as LAA closure, should be considered in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-Term Stroke Risk in Patients Undergoing Left Atrial Appendage Ablation With and Without Complete Isolation

Dhorepatil

Lang

et al. 2021

Front. Cardiovasc. Med.

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“…Significantly higher rates of freedom from AF were noted with the LARIAT group as compared to the standard ablation cohort (65% vs. 39%, p = .002). The recent EXCLUDE LAA study further reemphasized these findings (96.7% vs. 52.8%, p < .01) 101 . The ongoing randomized aMAZE Trial (NCT02513797) should provide further insight into the anti‐arrhythmic utility of LAAO.…”

Section: Special Considerationsmentioning

confidence: 95%

Current practice and future prospects in left atrial appendage occlusion

Narasimhan

Aedma

Bhatia

et al. 2021

Pacing Clinical Electrophis

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The thromboembolic complications of Atrial fibrillation (AF) remain a major problem in contemporary clinical practice. Despite advances and developments in anticoagulation strategies, therapy is complicated by the high risk of bleeding complications and need for meticulous medication compliance. Over the past few decades, the left atrial appendage has emerged as a promising therapeutic target to prevent thromboembolic events while mitigating bleeding complications and compliance issues. Emerging data indicates that it is a safe, effective and feasible alternative to systemic anticoagulation in patients with non‐valvular AF. A number of devices have been developed for endocardial or epicardial based isolation of the left atrial appendage. Increasing experience has improved overall procedural safety and ease while simultaneously reducing device related complication rates. Furthermore, increasing recognition of the non‐mechanical advantages of this procedure has led to further interest in its utility for further indications beyond the prevention of thromboembolic complications. In this review, we present a comprehensive overview of the evolution of left atrial appendage occlusion, commercially available devices and the role of this modality in the current management of AF. We also provide a brief outline of the landmark trials supporting this approach as well as the ongoing research and future prospects of left atrial appendage occlusion

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“…Upon deployment of the Lariat device, they demonstrated marked reductions of unipolar voltage from 1.1 ± 0.53 mV to 0.3 ± 0.38 mV (p<0.001) and bipolar voltage from 4.7 ± 2.83 mV to 0.6 ± 0.27 mV (p<0.001), in 94% of cases; ischemic necrosis distal to the site of ligation was hypothesized to be the underlying mechanism for these changes. Recently, Parikh et al have shown that the Lariat device is more efficacious than one-time endocardial radiofrequency ablation at producing LAAEI (96.7% vs. 52.8%, respectively; p<0.01) [36].…”

Section: Endo-epicardial Closure To Achieve Laaei -The Lariat Devicementioning

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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Exclusion of electrical and mechanical function of the left atrial appendage in patients with persistent atrial fibrillation: differences in efficacy and safety between endocardial ablation vs epicardial LARIAT ligation (the EXCLUDE LAA study)

Cited by 7 publications

References 18 publications

Long-Term Stroke Risk in Patients Undergoing Left Atrial Appendage Ablation With and Without Complete Isolation

Long-Term Stroke Risk in Patients Undergoing Left Atrial Appendage Ablation With and Without Complete Isolation

Current practice and future prospects in left atrial appendage occlusion

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

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