Management of focal atrial tachycardias originating from the atrial appendage with the combination of radiofrequency catheter ablation and minimally invasive atrial appendectomy

Guo, Xiaogang; Zhang, Jinlin; Ma, Jin; Jia, Yuhe; Zheng, Zhe; Wang, Hongyue; Su, Xi; Zhang, Shu

doi:10.1016/j.hrthm.2013.10.017

Cited by 49 publications

(50 citation statements)

References 24 publications

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“…In this context, little is known about the left atrial appendage (LAA), which has an underrecognized role as an AF trigger despite being an acknowledged source of focal automaticity [11][12][13][14][15]. Di Biase et al reported the LAA as a site of triggers and focal firing in 27% of 987 patients undergoing redo catheter AF ablation [16].…”

Section: Introductionmentioning

confidence: 99%

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Teixeira

Oliveira

Ramos

et al. 2017

J Interv Card Electrophysiol

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Purpose Recurrence of atrial fibrillation (AF) after catheter ablation is common, being clinically relevant to identify predictors of recurrence. The left atrial appendage (LAA) role as an AF trigger is scarcely explored. Our aim was to identify if LAA volume is an independent predictor of AF recurrence after catheter ablation. Methods We analysed 52 patients (aged 54 ± 10 years, 58% male) with paroxysmal and persistent AF who underwent a first AF catheter ablation and had performed contrast-enhanced cardiac computed tomography (CT) prior to the procedure. Results The mean left atrial and LAA volumes measured by cardiac CT were 98.9 ± 31.8 and 9.3 ± 3.5 mL, respectively. All patients received successful pulmonary vein isolation and were followed up for 24 months. AF recurrence occurred in 17 patients (33%). LAA volume was significantly greater in patients with AF recurrence than in those without recurrence (11.3 ± 2.9 vs. 8.2 ± 3.4 mL; p = 0.002). Multivariable analysis using Cox regression revealed that LAA volume (hazard ratio 1.32; 95% confidence interval 1.12-1.55; p = 0.001) and persistent AF (hazard ratio 4.22; 95% confidence interval 1.48-12.07; p = 0.007) were independent predictors for AF recurrence. An LAA volume greater than 8.825 mL predicted AF recurrence with 94% sensitivity and 66% specificity. The Kaplan-Meier analysis showed a lower rate free from AF recurrence in the group with an LAA volume >8.825 mL (p < 0.001).Conclusions Larger LAA volume was associated with AF recurrence after catheter ablation in patients with paroxysmal and persistent AF.

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Section: Introductionmentioning

confidence: 99%

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Teixeira

Oliveira

Ramos

et al. 2017

J Interv Card Electrophysiol

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“…The LAA has long been recognized as a source of atrial tachycardias that can initiate AF [25,47]. Recent studies have demonstrated the value of electrically isolating the LAA to decrease the recurrence of AF [26,48].…”

Section: Rationale For the Amaze Trialmentioning

confidence: 99%

“…In contrast, it has long been known that arrhythmias originating from the LAA that are unresponsive to catheter ablation can be cured by epicardial exclusion of the LAA [25,51,52]. LAA ligation results in a permanent transmural lesion with atrophy of the LAA, achieving mechanical and electrical isolation of the LAA [28,53].…”

Section: Rationale For the Amaze Trialmentioning

confidence: 99%

“…The primary source of cardioembolic events is thought to originate as thrombus formation in the LAA [22][23][24]. Additionally, atrial tachycardias originating from the LAA can initiate AF, while the heterogeneous muscular structure of the LAA provides the necessary substrate to allow for re-entrant circuits that propagate and maintain AF [25][26][27]. Elimination of the LAA is a critical step in the surgical Cox-MAZE III procedure, leading to its success in reduction of stroke and maintenance of sinus rhythm.…”

Section: Introductionmentioning

confidence: 99%

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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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“…The role of LAA morphology in clinical risk stratification remains undefined at present, whilst the same microstructural elements that act as potential nidus for stroke are also thought to increase arrhythmia. Given the emerging role for LAA occlusion as a treatment strategy for refractory appendage arrhythmia, 178 the strategy of combined LAA closure with AF ablation requires further study to define the predicted reduction in stroke risk and recurrent AF. In addition to any arrhythmic effects, the clinical hemodynamic and humeral effects of LAA closure remain poorly defined and are the area of ongoing study.…”

Section: Unanswered Questionsmentioning

confidence: 99%

Left Atrial Appendage Exclusion for Atrial Fibrillation

et al. 2014

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SYNOPSIS Percutaneous left atrial appendage (LAA) closure is increasingly being used as a treatment strategy to prevent stroke in patients with atrial fibrillation (AF) who have contraindications to anticoagulants. A number of approaches and devices have been developed in the last few years, each with their own unique set of advantages and disadvantages. We review the published studies on surgical and percutaneous approaches to LAA closure; focusing on stroke mechanisms in AF, LAA structure and function relevant to stroke prevention, practical differences in procedural approach, and clinical considerations surrounding management.

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Management of focal atrial tachycardias originating from the atrial appendage with the combination of radiofrequency catheter ablation and minimally invasive atrial appendectomy

Cited by 49 publications

References 24 publications

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

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

Left Atrial Appendage Exclusion for Atrial Fibrillation

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