Feasibility and clinical efficacy of left atrial ablation for the treatment of atrial tachyarrhythmias in patients with left atrial appendage closure devices

BackgroundLeft atrial appendage (LAA) closure devices have been introduced recently as an alternative for oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (AF). Because of potential overlap of ablation target areas and the previously implanted LAA closure device, as well as potential complications such as mechanical damage to the device, left atrial (LA) ablation remains a subject of debate in these patients.ObjectiveWe report on the feasibility and clinical efficacy of LA ablation after implantation of LAA closure devices.MethodsEight patients (6 men; age 69 ± 8 years) with symptomatic paroxysmal AF (n = 5) or persistent AF (mean CHA2DS2-VASc score 3.6 ± 0.7, mean HAS-BLED score 3.6 ± 1.5) and previously implanted WATCHMAN (7 patients) or AMPLATZER Cardiac Plug (1 patient) LAA closure devices received radiofrequency-based LA ablation (4 via circumferential pulmonary vein isolation [CPVI], 4 via CPVI and additional LA linear lesions or complex fractionated atrial electrograms) after a mean of 201 days (range 41–756 days) after LAA closure.ResultsSuccessful LA ablation was achieved without device interference or periprocedural complications. After a mean of 503 days (range 113–1006 days), transesophageal echocardiography (TEE) was performed in all patients to assess for device-related complications. No device dislocation or leakage was observed. In 1 patient (12.5%), a device-related thrombus was found despite therapeutic OAC with dabigatran. Five patients (63%) remained in stable sinus rhythm, and no bleeding events or stroke occurred during a follow-up of 554 days (range 218–1006 days).ConclusionLA ablation after LAA closure appears to be feasible. Device-related thrombus formation in 1 patient suggests the need for further TEE examinations after LA ablation after LAA closure device implantation. Left atrial appendage (LAA) closure devices have been introduced recently as an alternative for oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (AF). Because of potential overlap of ablation target areas and the previously implanted LAA closure device, as well as potential complications such as mechanical damage to the device, left atrial (LA) ablation remains a subject of debate in these patients. We report on the feasibility and clinical efficacy of LA ablation after implantation of LAA closure devices. Eight patients (6 men; age 69 ± 8 years) with symptomatic paroxysmal AF (n = 5) or persistent AF (mean CHA2DS2-VASc score 3.6 ± 0.7, mean HAS-BLED score 3.6 ± 1.5) and previously implanted WATCHMAN (7 patients) or AMPLATZER Cardiac Plug (1 patient) LAA closure devices received radiofrequency-based LA ablation (4 via circumferential pulmonary vein isolation [CPVI], 4 via CPVI and additional LA linear lesions or complex fractionated atrial electrograms) after a mean of 201 days (range 41–756 days) after LAA closure. Successful LA ablation was achieved without device interference or periprocedural complications. After a mean of 503 days (range 113–1006 days), transesophageal echocardiography (TEE) was performed in all patients to assess for device-related complications. No device dislocation or leakage was observed. In 1 patient (12.5%), a device-related thrombus was found despite therapeutic OAC with dabigatran. Five patients (63%) remained in stable sinus rhythm, and no bleeding events or stroke occurred during a follow-up of 554 days (range 218–1006 days). LA ablation after LAA closure appears to be feasible. Device-related thrombus formation in 1 patient suggests the need for further TEE examinations after LA ablation after LAA closure device implantation.