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Left atrial appendage isolation

Luigi Di Biase, Jorge Romero, David Briceno, Miguel Valderrabano, Javier E Sanchez, Domenico G Della Rocca, Prasant Mohanty, Rodney Horton, G Joseph Gallinghouse, Sanghamitra Mohanty, Chintan Trivedi, Salwa Beheiry, Carola Gianni, Claude S Elayi, J David Burkhardt, Andrea Natale
BACKGROUND: Atrial fibrillation (AF) triggers within the coronary sinus (CS)/great cardiac vein (GCV) and the left atrial appendage (LAA) have been recognized as non-pulmonary veins (PV) triggers of AF. OBJECTIVE: The aim of our study is to report unusual pattern of LAA electrical isolation (LAAEI). METHODS: 488 consecutive patients undergoing catheter ablation for persistent or long standing persistent AF who showed firing from the LAA and or from the CS/GCV have been enrolled in this multicenter prospective study...
February 11, 2019: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Antonio Di Monaco, Federico Quadrini, Federica Troisi, Nicola Vitulano, Giacomo Cecere, Pietro Guida, Tommaso Langialonga, Massimo Grimaldi
AIMS: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation in paroxysmal atrial fibrillation (PAF). Studies reported that the PVI single procedure was able to achieve durable sinus rhythm without the need of antiarrhythmic drugs in 60-80% of patients with PAF. In this study, we report data regarding bilateral left lateral ridge ablation for PAF. METHODS: We retrospectively collected data of 120 consecutive patients (mean age 56 ± 10 years; 62% male) referred to our center to perform PVI...
February 11, 2019: Journal of Cardiovascular Medicine
Naohiko Kawaguchi, Kaoru Okishige, Yasuteru Yamauchi, Manabu Kurabayashi, Tomofumi Nakamura, Takehiko Keida, Tetsuo Sasano, Kenzo Hirao, Miguel Valderrábano
BACKGROUND: The left atrial myocardium (LAM) and coronary sinus (CS) musculature (CSM) generate atrial electrograms recorded inside the CS (AECSs). The vein of Marshall (VOM) courses the mitral isthmus (MI) and VOM ethanol infusion (EI-VOM) is useful to ablate it. Its detailed effect on the MI, which contains LAM, CSM and those connections, is unknown. OBJECTIVE: To investigate the impact of EI-VOM on the MI by assessing the AECS. METHODS: Eighty-four consecutive patients with atrial fibrillation undergoing MI ablation with successful EI-VOM were included...
January 30, 2019: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Duygu Kocyigit, Muhammed Ulvi Yalcin, Kadri Murat Gurses, Gamze Turk, Selin Ardali, Ugur Canpolat, Banu Evranos, Hikmet Yorgun, Tuncay Hazirolan, Kudret Aytemir
AIMS: Pulmonary vein isolation (PVI) using cryoballoon has been accepted as a safe and effective method for treatment of atrial fibrillation (AF). Despite advances in catheter-based technologies, some patients still experience AF recurrence. In this study, we aimed to compare left atrial appendage (LAA) morphology in AF patients and subjects with sinus rhythm and also investigate the association between LAA morphology and success of PVI using cryoballoon in subjects with AF. METHODS: In this prospective study, 359 AF patients who underwent pre-ablation computed tomographic angiography (CTA) scan between January 2013-March 2016 were included as the patient group...
January 4, 2019: Journal of Cardiovascular Computed Tomography
Varuna K Gadiyaram, Sanghamitra Mohanty, Carola Gianni, Chintan Trivedi, Amin Al-Ahmad, J David Burkhardt, G Joseph Gallinghouse, Patrick M Hranitzky, Rodney P Horton, Javier E Sanchez, Domenico G Della Rocca, Luigi Di Biase, Matthew J Price, Linda Couts, Douglas Gibson, Andrea Natale
INTRODUCTION: Electrical isolation of the left atrial appendage (LAA) is an important adjunctive ablation strategy in patients with non-paroxysmal atrial fibrillation (AF). Patients that have impaired LAA contractility following isolation may require long-term oral anticoagulant (OAC) therapy irrespective of their CHADS2 -VASc score. Percutaneous LAA occlusion (LAAO) is a potential alternative to lifelong OAC therapy. We aimed to assess the rate of OAC discontinuation and thromboembolic (TE) events following percutaneous LAAO in patients who underwent LAA electrical isolation (LAAI)...
January 8, 2019: Journal of Cardiovascular Electrophysiology
Brad Clark, Sarah Whittam, Asim Ahmed, Eric N Prystowsky, Benzy J Padanilam
Around week five of embryological development, a single common pulmonary vein (PV) opens into the primitive left atrium. This common vein and proximal parts of the branches are progressively absorbed into the left atrium until the formation of four separate PVs. Ultimately, almost the entire left atrium barring the left atrial appendage, the rim of tissue around the mitral valve and parts of septum are formed from the incorporated PVs. Pulmonary vein anatomy differs between patients and may have its basis in the varying incorporation of the initial common PV into the developing left atrium...
January 4, 2019: Journal of Cardiovascular Electrophysiology
Sanghamitra Mohanty, Luigi Di Biase, Chintan Trivedi, Fahim Choudhury, Domenico G Della Rocca, Jorge Romero, Carola Gianni, Javier Sanchez, Patrick Hranitzky, G Joseph Gallinghouse, Amin Al-Ahmad, Rodney P Horton, David Burkhardt, Andrea Natale
INTRODUCTION: It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients. METHODS: Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non-PV) triggers were ablated based on operator's discretion...
December 21, 2018: Journal of Cardiovascular Electrophysiology
Shaojie Chen, Boris Schmidt, Stefano Bordignon, Laura Perrotta, Fabrizio Bologna, Takahiko Nagase, K R Julian Chun
INTRODUCTION: Pulmonary vein isolation (PVI) is the cornerstone ablation strategy for treatment of atrial fibrillation (AF). Ablation outside the PVs is sometimes desired particularly in persistent or long-standing AF. This study reported left atrial appendage isolation (LAAI) using cryoballoon (CB) focusing on the technical data and short-term clinical follow-up. METHODS AND RESULTS: Patients with recurrent persistent AF after multiple AF procedures were enrolled...
December 21, 2018: Journal of Cardiovascular Electrophysiology
Thomas Fink, Michael Schlüter, Christian-Hendrik Heeger, Christine Lemeš, Tilman Maurer, Bruno Reissmann, Laura Rottner, Francesco Santoro, Roland Richard Tilz, Hannes Alessandrini, Andreas Rillig, Shibu Mathew, Peter Wohlmuth, Qizhi Fang, Randall Lee, Feifan Ouyang, Karl-Heinz Kuck, Andreas Metzner
OBJECTIVES: This study investigated the outcome of wide-area left atrial appendage isolation (WLAAI) and subsequent LAA ligation in patients with recurrent atrial arrhythmias after pulmonary vein isolation (PVI). BACKGROUND: LAA isolation and ligation may improve rhythm control and prevent LAA thrombus formation in patients with atrial fibrillation who do not respond to PVI. METHODS: Patients (n = 31, mean age: 69.7 ± 7.8 years, 18 men) with arrhythmia recurrence after established PVI undergoing WLAAI with subsequent LAA ligation (LARIAT+ device) were studied...
December 2018: JACC. Clinical Electrophysiology
Nishant Verma, Bradley P Knight
No abstract text is available yet for this article.
December 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Yun Gi Kim, Jaemin Shim, Suk-Kyu Oh, Kwang-No Lee, Jong-Il Choi, Young-Hoon Kim
BACKGROUND: Electrical isolation of the left atrial appendage (LAA) is associated with a lower rate of atrial fibrillation (AF) recurrence in patients undergoing radiofrequency catheter ablation. However, LAA isolation can significantly impair LAA contractility. OBJECTIVE: This study was performed to evaluate whether electrical isolation of the LAA is associated with an increased risk of ischemic stroke or transient ischemic attack (TIA). METHODS: Consecutive patients with AF undergoing radiofrequency catheter ablation at Korea University Medical Center Anam Hospital were analyzed...
December 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Takahiko Nagase, Stefano Bordignon, Laura Perrotta, Fabrizio Bologna, Nikolaos Tsianakas, Shaojie Chen, Athanasios Konstantinou, Julian K R Chun, Boris Schmidt
BACKGROUND: It remains unclear whether left atrial low-voltage area (LALVA) affects atrial tachyarrhythmia recurrence after laser balloon pulmonary vein isolation (PVI) for atrial fibrillation (AF). We prospectively evaluated the outcome of laser balloon PVI in patients with and without LALVA (≤ 0.5 mV) together with surface/intracardiac electrophysiological criteria. METHODS: One hundred consecutive paroxysmal/persistent AF patients underwent laser balloon PVI...
November 20, 2018: Pacing and Clinical Electrophysiology: PACE
Nitish Badhwar, Ghannam Al-Dosari, Jonathan Dukes, Randall J Lee
Two patients with long-standing atrial fibrillation (AF) refractory to medical management and with prior pulmonary vein isolation underwent a new hybrid epicardial/endocardial subxyphoid approach for AF ablation and left atrial appendage (LAA) ligation. Pulmonary vein and LA posterior wall isolation, as well as LAA exclusion were achieved in both patients. There were no procedural complications. Both patients remain in sinus rhythm. Both patients are off antiarrhythmic medications.
June 2018: Journal of Atrial Fibrillation
Sri Sundaram, William Choe, J Ryan Jordan, Charles Boorman, Nate Mullins, Austin Davies, Austin Stucky, Sunil Nath
Background: This study describes the use of lesion index (LSI) as a direct measure to assess the adequacy of ablation lesion formation with force-sensing catheters in ablation of paroxysmal atrial fibrillation (PAF). LSI is calculated by the formula:LSI = CF (g) ×Current (mA) ×Time (sec). Methods: Fifty consecutive patients with PAF underwent pulmonary vein (PV) isolation using a catheter dragging technique and targeting different LSI values in different anatomical areas...
June 2018: Journal of Atrial Fibrillation
Antonio Madaffari, Anett Große, Elisabetta Conci, J Christoph Geller
Left atrial appendage (LAA) may be the source for initiation and maintenance of atrial fibrillation (AF). This report shows restoration of sinus rhythm in the atria during radiofrequency wide-area LAA electrical isolation, whereas AF persists in the LAA.
November 5, 2018: Pacing and Clinical Electrophysiology: PACE
Luigi Di Biase, Andrea Natale, Jorge Romero
Understanding the anatomy, physiology, and arrhythmogenic and thrombogenic roles of the left atrial appendage (LAA) has become very important. The potential deleterious effects of this chamber in patients with atrial fibrillation have led to the development of specific treatments for this structure. It has been established that the LAA is the area where the vast majority of thrombi in nonvalvular atrial fibrillation are formed and that some LAA morphologies may actually facilitate thrombi formation and risk stratification for thromboembolic events in patients with low CHA2 DS2 -VASc scores...
October 30, 2018: Circulation
Petra Kleinbongard, Nilguen Gedik, Mücella Kirca, Leanda Stoian, Ulrich Frey, Afsaneh Zandi, Matthias Thielmann, Heinz Jakob, Jürgen Peters, Markus Kamler, Gerd Heusch
Background Remote ischemic preconditioning ( RIPC ) by repeated brief cycles of limb ischemia/reperfusion attenuates myocardial ischemia/reperfusion injury. We aimed to identify a functional parameter reflecting the RIPC -induced protection in human. Therefore, we measured mitochondrial function in right atrial tissue and contractile function of isolated right atrial trabeculae before and during hypoxia/reoxygenation from patients undergoing coronary artery bypass grafting with RIPC or placebo, respectively...
August 7, 2018: Journal of the American Heart Association
Ahmet Adiyaman, Thomas J Buist, Rypko J Beukema, Jaap Jan J Smit, Peter Paul H M Delnoy, Martin E W Hemels, Hauw T Sie, Anand R Ramdat Misier, Arif Elvan
BACKGROUND: Current guidelines recommend both percutaneous catheter ablation (CA) and surgical ablation in the treatment of atrial fibrillation, with different levels of evidence. No direct comparison has been made between minimally invasive thoracoscopic pulmonary vein isolation with left atrial appendage ligation (surgical MIPI) versus percutaneous CA comprising of pulmonary vein isolation as primary treatment of atrial fibrillation. We, therefore, conducted a randomized controlled trial comparing the safety and efficacy of these 2 treatment modalities...
October 2018: Circulation. Arrhythmia and Electrophysiology
Ahmed AlTurki, Thao Huynh, Ahmed Dawas, Hussain AlTurki, Jacqueline Joza, Jeff S Healey, Vidal Essebag
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...
October 2018: Journal of Arrhythmia
Satoshi Miyazawa, Seiji Fukamizu, Iwanari Kawamura, Rintaro Hojo
A 79-year-old woman with a history of pulmonary vein isolation for persistent atrial fibrillation was admitted for recurrence of atrial tachycardia, with a tachycardia cycle length of 236 milliseconds. The ultra-high-resolution mapping system revealed that tachycardia circuit detouring the epicardium at the anterior wall scar and breaking through to the endocardium below the left atrial appendage. Radiofrequency energy was applied to this site, which successfully terminated the tachycardia. This case suggests that epicardial conduction could occur even at the left atrial anterior wall and identifies a variation in epicardial conduction around the left atrium, which could be a tachycardia circuit...
October 4, 2018: Journal of Cardiovascular Electrophysiology
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