Consider benefit, embolic event risk in left atrial appendage isolation

CHICAGO — Electrical isolation of the left atrial appendage during reablation in patients with recurrent atrial fibrillation may confer benefit but is also associated with an increased risk for embolic events, researchers reported at the Heart Rhythm Society Annual Scientific Sessions.

“Ectopics from the left atrial appendage (LAA) can act as triggers for AF and electrical isolation of the LAA may improve outcomes in recurrent AF during reablation procedures. Yet, this ablation strategy may be associated with an increased risk of LAA thrombus formation and embolic events,” Christian H. Heeger, MD, from the Asklepios Klinik St. Georg in Hamburg, Germany, and colleagues wrote in an abstract.

Heeger and colleagues prospectively enrolled 71 patients with LAA isolation. In terms of ablation strategies, pulmonary vein isolation was used in all patients. Additional ablation of a left atrial isthmus line was conducted in 92%, anterior line in 90%, complex atrial fractionated potentials in 62% and roof line in 30%.

Christian H. Heeger

LAA isolation was achieved after an average of two previous procedures, and transesophageal echocardiography was performed after an average of 10.3 months. The researchers also strongly recommended oral anticoagulation independent of individual CHA₂DS₂-VASC score.

During an average follow-up of 63 months, 30% of patients remained in stable sinus rhythm. Twenty-one months after the initial procedure, 72% of patients with recurrence of AF or atrial tachycardia underwent a further catheter ablation procedure. Forty-six percent of patients remained in stable sinus rhythm after an average of 1.5 LAA isolation procedures and 46 months, and 18% of patients developed embolic stroke, according to the data.

Results also showed that 17% of patients on oral anticoagulants developed LAA thrombus formation.

Only a relatively small number of patients achieved stable sinus rhythm after LAA isolation, and stroke risk remains high, the researchers noted.

“Left atrial appendage thrombus isolation should be taken into consideration due to moderate benefit and potential risk of embolic events in clinical practice. Furthermore, a LAA closure should be considered in those patients to maybe prevent LAA thrombi and embolic stroke,” they wrote in their abstract. – by Melissa Foster

Reference:

Heeger CH. Abstract AB14-02. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 10-13, 2017; Chicago.

Disclosure: Heeger reports no relevant financial disclosures.