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Adding LAA ligation to conventional ablation improves outcomes
The addition of left atrial appendage closure to traditional ablation improved 1-year atrial fibrillation outcomes compared with ablation only, according to recent findings.
The aim of the prospective observational study was to assess how the use of the left atrial appendage (LAA) closure system (Lariat) procedure before conventional AF ablation affects patients with persistent AF.
The current data set included 138 patients with persistent AF in age- and sex-matched groups, with 69 patients treated with the Lariat procedure followed by AF ablation after 30 days or more, and 69 controls undergoing ablation alone. Freedom from AF at 1 year off of anti-arrhythmic therapy after one ablation procedure was the primary endpoint.
Patients in the Lariat arm demonstrated larger left atrial size, CHADS2, CHADSVasc and HAS-BLED scores than those who underwent ablation only. However, the type of lesions during AF ablation were similar in both groups.
Patients in the Lariat arm were more likely to reach the primary endpoint compared with controls (65% vs. 39%; P = .002). Exclusion of patients with a history of AF ablation yielded similar results (62% vs. 41%; P = .028).
Repeat ablation due to recurrence also was more frequent in the ablation-only group (16% vs. 33%; P = .018). Among patients who required more than one ablation procedure, patients treated with the Lariat device were significantly more likely to reach the primary endpoint (77% vs. 58%; P = .018).
The median time to recurrence in the ablation-only group was 19 weeks (interquartile range [IQR], 11-25 weeks) vs. 27 weeks in the Lariat group (IQR, 20-40 weeks; P = .03).
Multivariable analysis results indicated that advanced age (OR = 1.043; P = .037 per 1 year) and higher left atrial volume at baseline (OR = 1.021; P = .003 per ml) independently predicted 1-year AF recurrence, along with failure to undergo the Lariat procedure (OR = 3.343; p = .004).
“The LAA is an important site for AF initiation and maintenance, and its exclusion using a Lariat device as an adjunct to conventional AF ablation appears to decrease the recurrence of AF in patients with persistent AF,” the researchers concluded. – by Rob Volansky
Disclosure: The researchers report associations with a number of device and pharmaceutical companies. Please see the full study for a list of all authors’ relevant financial disclosures.