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Left atrial appendage closure reduces burden in nonparoxysmal AF
Left atrial appendage closure appears to reduce the burden of nonparoxysmal atrial fibrillation, according to recent findings.
In a prospective, multicenter observational study, researchers evaluated 50 consecutive patients with nonvalvular AF and cardiac implantable electronic devices who underwent left atrial appendage (LAA) closure with the LARIAT device (SentreHEART). The patients were enrolled from July 2010 to April 2013. Eligible patients were aged at least 18 years, had at least one risk factor for embolic stroke and were considered poor or ineligible candidates for warfarin therapy. The mean age of the patient population was 70 ± 8.4 years, and the mean duration of AF was 54 ± 40 months.
All patients were followed up at three and 12 months after the LARIAT procedure. At baseline and at each follow-up visit, interrogation of cardiac implantable electronic devices was conducted to ascertain AF burden, with the devices reset at each visit to determine burden during the intervening period. Medication lists were also updated at each visit to safeguard the stability of antiarrhythmic drug regimens.
Compared with the baseline AF burden of 76% ± 33%, the burden at 3 months was significantly decreased (42% ± 34%; P < .0001). This reduction persisted at the 12-month follow-up (59% ± 26%; P < .001). Results from subgroup analysis indicated a similar decrease in AF burden between patients with paroxysmal AF (n = 19) and nonparoxysmal AF (n = 31) at 3 months. At the 12 month follow-up, the decreased AF burden persisted among those with non-paroxysmal AF, but not those with paroxysmal AF.
In the nine patients for whom LAA was due to triggered activity/atrial tachycardia, the AF burden was significantly decreased at 3 (52% ± 35%) and 12 months (42% ± 19%) compared with baseline (84 ± 31%, P < .0001 for both comparisons). The researchers also noted that the reduction to AF burden was significantly lower among three patients who had incomplete LAA closure at both follow-up visits.
“This study clearly highlights the value of LAA electrical exclusion in decreasing the overall arrhythmia burden,” the researchers wrote. “This method could be used as a potential adjunctive strategy in improving the efficacy of AF ablation for rhythm control while mechanically excluding the source of thrombus formation in the LA.”
Disclosure: See the full study for a list of relevant financial disclosures.