To “isolate” or “not to isolate,” the left atrial appendage, “that is the question”

Biase, Luigi Di

doi:10.1007/s10840-016-0174-x

Cited by 1 publication

(3 citation statements)

References 25 publications

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“…Distal isolation is performed by circumferential ablation at the ostium of the LAA. Furthermore, a large proportion of these patients have an ongoing indication for anticoagulation due to their CHADS‐VASc score >2 regardless of having undergone LAA isolation 41. In contrast, Rillig et al found that 21% of patients developed an LAA thrombus after LAA ablation despite 90% of patients receiving oral anticoagulation at the time.…”

Section: Discussionmentioning

confidence: 99%

“…The major concerns of the use of LAA ablation are increased thromboembolic risk, perforation, and phrenic nerve injury 40. LAA isolation may lead to the formation of thrombus in the LAA due to decreased contractility 18, 41. At odds with this hypothesis, Di Biase et al32 and Park et al18 showed that 50% of patients have flow velocity in the LAA that is within the normal range after LAA isolation.…”

Section: Discussionmentioning

confidence: 99%

“…Anticoagulation should be continued after the procedure, although concomitant ligation of the LAA may provide the added benefit of preventing thrombus formation and reducing the need for anticoagulation 40. Given the theoretical increased risk of stroke due to decreased contraction of the LAA, transesophageal echocardiography is usually performed around 6 months after the ablation to rule out the presence of thrombus 6, 41. Reassuringly, there were no transient ischemic attacks or strokes in the LAA isolation groups, although long‐term follow‐up was limited.…”

Section: Discussionmentioning

confidence: 99%

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Left atrial appendage isolation in atrial fibrillation catheter ablation: A meta‐analysis

AlTurki

Huynh

Dawas

et al. 2018

Journal of Arrhythmia

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A significant proportion of patients’ experience recurrence of atrial fibrillation (AF) despite pulmonary venous isolation (PVI), especially those with persistent AF. Isolation of the left atrial appendage (LAA) may reduce AF recurrence. The aim of this study was to assess the efficacy of LAA isolation in addition to PVI compared with PVI alone. We conducted a comprehensive search of electronic databases, up to April 21st, 2017, for all studies comparing the effect LAA electrical isolation or ligation in addition to PVI, as opposed to PVI alone, on the recurrence of atrial fibrillation after catheter ablation. We used random‐effects meta‐analysis models to summarize the studies. One RCT and four observational studies enrolling 781 patients were retained. Four studies assessed the added effect of LAA catheter ablation, and one study evaluated the effect of LAA ligation with the aim of LAA electrical isolation. Four studies exclusively enrolled patients with persistent atrial fibrillation and one study predominantly enrolled patients with persistent atrial fibrillation. Follow‐up ranged from 12 to 15 months. The addition of LAA isolation to PVI reduced AF recurrence compared with the latter alone (odds ratio (OR) = 0.19; 95% confidence intervals (CI) = 0.10‐0.37; P < 0.00001). Left atrial appendage isolation was also associated with a reduction in AF recurrence after repeat ablation (OR = 0.40; CI = 0.25‐0.65; P = 0.0003). The addition of LAA isolation to PVI was associated with a decrease in AF recurrence in patients with persistent AF. Further studies are needed to assess the effect on long‐term risk of stroke.

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Section: Discussionmentioning

confidence: 99%