Feasibility and clinical efficacy of left atrial ablation for the treatment of atrial tachyarrhythmias in patients with left atrial appendage closure devices

Abstract

LA ablation after LAA closure appears to be feasible. Device-related thrombus formation in 1 patient suggests the need for further TEE examinations after LA ablation after LAA closure device implantation.

Catheter Ablation for Atrial Fibrillation in Patients With Watchman Left Atrial Appendage Occlusion Device: Results from a Multicenter Registry

“…LAA isolation was attempted in 28% of patients with successful electrical isolation, and was achieved in 58%. Despite extensive ablation in our study, the mean procedure and fluoroscopy time of were comparable to the previous experiences . The data regarding optimal duration of waiting prior to RFA in Watchman LAAO device remain unclear at this time.…”

“…Furthermore, catheter‐device contact and delivery of RF energy at the site of previous endothelialization of the Watchman LAAO device can lead to peri‐device leaks, device dislodgement and subsequent thrombus formation. One patient from the earlier reported study had a thrombus formation at the site of the Watchman device . None of our patients had any issue of automatic generator shut off during RFA or evidence of thrombus at the device site on follow‐up.…”

“…In addition, 2 patients underwent linear ablation, 3 patients underwent CFAE‐guided focal ablation targeting the roof, interatrial septum, LA posterior wall and base of LAA. The other study by Heeger et al . demonstrated safety and feasibility of RFA in 7 patients with Watchman LAAO device and 1 patient with Amplatzar Cardiac Plug.…”

“…reported a 5‐year experience including 98 high‐risk AF patients on safety and efficacy of a combined approach with PV isolation ± CFAE or linear ablation as the initial procedure followed by successful Watchman LAAO device implantation in all patients . To date, to the best of our knowledge there are only 2 other small studies including 10 and 8 patients, respectively, that reported outcomes of RFA in AF patients with preexisting LAAO device . The minimum duration between RFA and Watchman LAAO occlusion device implantation as reported by Walker et al .…”

Novel stroke risk reduction in atrial fibrillation: left atrial appendage occlusion with a focus on the Watchman closure device

“…In another study, satisfactory data were shown on freedom of AF and OAC discontinuation, but unfortunately, severe complications in terms of cardiac tamponade occurred in three patients (8.6%) 71. In another small study, the feasibility of AF ablation 41–756 days after LAA closure using Watchman or Amplatzer device was shown 72. The major concern here was that in one of the eight studied patients, a device-related thrombus was found despite using NOAC.…”