Impact of left atrial appendage exclusion using an epicardial ligation system (LARIAT) on atrial fibrillation burden in patients with cardiac implantable electronic devices

Afzal, Muhammad R.; Kanmanthareddy, Arun; Earnest, Matthew; Reddy, Madhu; Atkins, Donita; Bommana, Sudharani; Bartus, K; Rasekh, Abdi; Han, Fred; Badhwar, Nitish; Cheng, Jie; DiBiase, Luigi; Ellis, Christopher R.; Dawn, Buddhadeb; Lee, Randall J.; Lakkireddy, Dhanunjaya

doi:10.1016/j.hrthm.2014.09.053

Cited by 85 publications

(58 citation statements)

References 19 publications

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“…Lakkireddy and colleagues 11 observed that the atrial arrhythmia burden decreased from 81% to 47% three months after the LAA ligation. In Afzal and associates' study, 12 significant reductions in AF burden were reported in patients with known AF triggers inside the LAA (n=9) at 3-month (52% ± 35%) and 12-month (42% ± 19%) follow-up evaluations, in comparison with the respective baseline figures (84% ± 31%; P <0.0001). The LAA Ligation Adjunctive to PVI for Persistent or Longstanding Persistent Atrial Fibrillation (aMAZE) Trial to Evaluate Lariat Ligation of the Left Atrial Appendage 13 is designed to evaluate the success rate of AF ablation with and without concomitant LAA exclusion.…”

Section: The Amaze Trialmentioning

confidence: 81%

“…The results of Left Atrial Appendage Ligation and Ablation for Persistent Atrial Fibrillation study (the LAALA-AF Registry) 11 and other independent studies 12 have introduced the possible role of the Lariat ® Suture Delivery Device (SentreHeart, Inc.; Redwood City, Calif ) ligation in decreasing the burden of arrhythmia in patients who have AF. Lakkireddy and colleagues 11 observed that the atrial arrhythmia burden decreased from 81% to 47% three months after the LAA ligation.…”

Section: The Amaze Trialmentioning

confidence: 99%

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Update on Atrial Fibrillation

Safavi‐Naeini¹,

Rasekh²

2016

Texas Heart Institute Journal

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A trial fibrillation (AF), the most prevalent cardiac arrhythmia, is categorized into 4 different groups on the basis of the duration of the arrhythmia episodes. If AF terminates spontaneously or with intervention within 7 days from onset, it is paroxysmal AF; AF of more than 7 days in duration is persistent AF; continuous AF of more than one year's duration is longstanding persistent AF; and permanent AF is the condition that ensues when the patient and his or her physician mutually decide not to pursue the restoration or maintenance of sinus rhythm by any means. 1Atrial fibrillation is the single most important cause of ischemic stroke, and patients with AF are 5 times more likely to have a stroke than are those without the condition. At least 90% of blood clots responsible for stroke in patients with AF originate from the left atrial appendage (LAA).3 Catheter ablation has proved an effective treatment for AF, resulting in approximately a 54% success rate in paroxysmal and a 42% in nonparoxysmal types of AF, after a single procedure and at long-term follow-up evaluation. 4 In this review, we evaluate the possible role of contact force (CF) technology and LAA exclusion to improve the AF ablation outcome. Carto SmartTouch TechnologyThe Carto ® ThermoCool SmartTouCh ® Catheter (Biosense Webster, Inc., a Johnson & Johnson company; Diamond Bar, Calif ) is the first therapeutic catheter approved in the United States that has the capability of direct and real-time measurement of CF during the catheter ablation procedure, for the treatment of drug-resistant paroxysmal AF, sustained monomorphic ischemic ventricular tachycardia, or type I atrial flutter.5 The paroxysmal-AF catheter ablation trial with a CF-sensing catheter (SMART-AF Trial) was a multicenter (performed at 21 sites in the U.S.), prospective, nonrandomized study that enrolled 172 patients who had histories of at least 3 symptomatic episodes of paroxysmal AF within the previous 6 months, and of at least one antiarrhythmic drug failure. Trial results indicated the safety and increasing success rate of the paroxysmal-AF ablation procedure with use of the ThermoCool SmartTouCh catheter. 5Among the 172 enrolled patients, 161 (mean age, 58.3 ± 10.93 yr) began the procedure with catheter insertion; radiofrequency ablation was performed in 160 of these patients, and 117 patients continued the 12-month follow-up protocol, to be evaluated for effectiveness. 5 The overall success rate of catheter ablation was 74% at the one-year follow-up evaluation of patients, vs a 66% success rate at one year when performed out of the selected range. The success rate increased to 81% when consistent and stable application of CF was achieved (a targeted range was maintained ≥80% of the time). The SMART-AF trial results showed that the use of CF therapy leads to an improved success rate of AF ablation procedures for patients undergoing catheter ablation. 5 TactiCath Quartz Ablation CatheterThe TactiCath Quartz CF ablation catheter (St. Jude Medical, Inc.; St. Paul, Minn) has imp...

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Section: The Amaze Trialmentioning

confidence: 81%

Section: The Amaze Trialmentioning

confidence: 99%

Update on Atrial Fibrillation

Safavi‐Naeini¹,

Rasekh²

2016

Texas Heart Institute Journal

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“…LAA ligation results in a permanent transmural lesion with atrophy of the LAA, achieving mechanical and electrical isolation of the LAA [28,53]. Permanent closure of the LAA results in a decrease in AF burden, and results in conversion of persistent AF to sinus rhythm in 8% of patients [54,55].…”

Section: Rationale For the Amaze Trialmentioning

confidence: 99%

Evolution of Catheter Based Therapies for Persistent and Long-Standing Persistent Atrial Fibrillation: The Amaze Trial

Badhwar¹,

Lee²

2017

Health Care Current Reviews

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Atrial fibrillation (AF) is the most common arrhythmia of man and the incidence of AF increases with age. AF is known to increase the risk of stroke, heart failure and death. Patients with persistent and longstanding persistent AF generally do not respond to medications. Catheter ablation of AF is associated with a high rate of success in patients with paroxysmal AF. However, once a patient develops persistent or longstanding persistent AF, the outcomes of curing AF drop dramatically with catheter ablation. The development of new technologies and procedures has allowed physicians to perform catheter-based procedures that could previously be done only with cardiac surgery. One such technological development is the LARIAT procedure that allows cardiac electrophysiologists and surgeons to percutaneously exclude the left atrial appendage (LAA) and perform catheter ablation resulting in a percutaneous alternative to the open-chested surgical procedure, the Cox-Maze procedure. The AMAZE trial is a prospective, multi-center trial that was designed to evaluate the safety and effectiveness of the LARIAT procedure to percutaneously exclude the LAA; and to determine if LAA exclusion combined with catheter based pulmonary vein isolation improves maintenance of sinus rhythm in patients with persistent or long standing persistent AF. The mini-review will describe the epidemiology of AF, review current treatment of AF and provide the rationale and status for the AMAZE trial.

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“…Among the 18 patients in that study, the AF bur- 14 den decreased from a baseline of 81% to 47% after ligation (P <0.01). 18 Afzal and associates 19 recorded the AF burden before LAA exclusion (baseline), and twice later, at 3 and 12 months after exclusion. According to this study, the AF burden at the 3-month follow-up evaluation was 42% ± 34%, significantly lower than that at baseline (76% ± 33%; P <0.0001); and the reduction of AF burden was fairly well sustained at 12 months (59% ± 26%; P <0.001).…”

Section: Impact Of Lariat Laa Exclusion On Atrial Fibrillation Burdenmentioning

confidence: 99%

Where We Stand on Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation

Safavi‐Naeini¹,

Rasekh²

2016

Texas Heart Institute Journal

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A trial fibrillation (AF) is the most prevalent cardiac arrhythmia-found in 1% to 2% of the general population.1 It is also a major cause of ischemic stroke. Patients with AF are 4 to 5 times more likely to have an ischemic stroke.2 Their annual rate of stroke is 5%, which accounts for 15% of all strokes in the United States.2,3 The left atrial appendage (LAA) is a trabeculated cul-de-sac that is responsible for more than 90% of thrombus formations in AF patients. 4 Because of these findings, LAA closure devices have been developed as an alternative to oral anticoagulant (OAC) therapy.The first generation of endocardial LAA occluders comprised 3 devices: the Percutaneous LAA Transcatheter Occlusion system (Plaato) (ev3 Inc.; Plymouth, Minn), the Watchman Left Atrial Appendage Closure Device (Boston Scientific Corporation; Natick, Mass), and the Amplatzer Cardiac Plug (ACP) device (St. Jude Medical, Inc.; Minneapolis, Minn). Plaato withdrew from the market in 2006, and the ACP is not yet available for commercial use in the U.S. 5The newer generation of endocardial LAA occluders comprises the WaveCrest ® LAA Occlusion System (Coherex Medical, Inc.; Salt Lake City, Utah), the LAmbre Left Atrial Appendage Occluder (Lifetech Scientific [Shenzhen] Co., Ltd.; Shenzhen, PRC), and the Ultrasept LAA Closure Device (Cardia Inc.; Eagan, Minn), none of which is available for commercial use in the U.S. 6 If you prefer to perform LAA closure through an epicardial approach, the Lariat ® Suture Delivery Device (SentreHeart, Inc.; Redwood City, Calif ) and the Aegis device (Aegis Medical Innovations Inc.; Vancouver, Canada) will permit that. But the Aegis device is available for investigational use only. 6 The Watchman Clinical Trial ExperienceThe Watchman LAA Closure Technology for Embolic Protection in Patients with Atrial Fibrillation (Protect AF) clinical trial was designed to examine the safety and efficacy of the Watchman device in patients with nonvalvular AF who were eligible for warfarin therapy and had a CHADS 2 stroke-risk score of 1 or greater.7 From February 2005 through June 2008, 707 patients at 59 centers in the U.S. and Europe were enrolled in the Protect AF study. The patients were randomly assigned in a 2:1 ratio to percutaneous closure of the LAA and subsequent discontinuation of warfarin (n=463), or to warfarin treatment. All patients were monitored for 12 months. The Protect AF trial showed that the Watchman LAA Closure is noninferior to warfarin for the combined endpoint of stroke, systemic embolism, and death, and it is a safe and effective alternative to OAC therapy in decreasing the risk of AF-related stroke. 7,8 The Protect AF trial showed a high rate (8.7%) of implant device-related sequelae, including perforations and pericardial effusions, and had a procedural failure rate of around 9%. However, most of these events occurred during the early stages of the trial, and procedural failure rates declined as surgeons became more experienced with the operation. According to the Protect AF trial, the U.S....

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Impact of left atrial appendage exclusion using an epicardial ligation system (LARIAT) on atrial fibrillation burden in patients with cardiac implantable electronic devices

Cited by 85 publications

References 19 publications

Update on Atrial Fibrillation

Update on Atrial Fibrillation

Evolution of Catheter Based Therapies for Persistent and Long-Standing Persistent Atrial Fibrillation: The Amaze Trial

Where We Stand on Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation

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