Surgical LAAO during thoracoscopic epicardial AF ablation in heart failure patients resulted in a MACE rate of 8.8% vs 23.1% without LAAO (HR 2.83 for non-LAAO; 95% CI 0.77-10.41; p=0.117).
Cohort (n=127)
Does surgical LAAO during thoracoscopic epicardial AF ablation improve rhythm and cardiac function in patients with AF and HF?
Surgical LAAO during thoracoscopic epicardial AF ablation in patients with HF is associated with more durable pulmonary vein isolation and does not worsen postoperative diastolic function.
Effect estimate: HR 2.83 (95% CI 0.77-10.41)
Absolute Event Rate: 8.8% vs 23.1%
p-value: p=0.117
ABSTRACT Background The left atrial appendage represents the main source of thrombus formation in patients with atrial fibrillation (AF). The LAA plays an important role in LA reservoir function, especially in patients with heart failure (HF). Limited data are available regarding the efficacy of surgical left atrial appendage occlusion (LAAO) during thoracoscopic epicardial AF ablation for improving rhythm and cardiac function. Methods Patients who underwent thoracoscopic epicardial AF ablation with or without LAAO for AF combined with HF from February 2012 to November 2023 were included. Recurrence of AF, major adverse cardiovascular events (MACE), redo catheter ablation findings, and echocardiographic outcomes were compared between groups. Results Among 127 patients, 13 (10.2%) did not receive LAAO according to their physicians' discretion. The atrial tachyarrhythmia recurrence tended to be higher in the non‐LAAO group (hazard ratio HR 1.38, 95% confidence interval CI 0.68–2.78, p = 0.375). Of the 34 patients who underwent electrophysiology studies, the left pulmonary vein (PV) reconnection rate was significantly higher in the non‐LAAO group (odds ratio 19.5, 95% CI 1.61–236.61, p = 0.020). MACE was observed more frequently in the non‐LAAO group compared to the LAAO group (23.1% vs. 8.8%, HR 2.83, 95% CI 0.77–10.41, p = 0.117). Adjusted analyses showed lower postoperative E / e ′ in the LAAO group than in the non‐LAAO group ( p = 0.014). Conclusions Surgical LAAO during thoracoscopic epicardial AF ablation was effective for maintaining durable PV isolation in patients with HF. Thoracoscopic epicardial AF ablation improves LV systolic function regardless of LAAO status, and LAAO was not associated with worsening postoperative diastolic function.
Park et al. (Mon,) conducted a cohort in Atrial fibrillation combined with heart failure (n=127). Surgical left atrial appendage occlusion (LAAO) during thoracoscopic epicardial AF ablation vs. Thoracoscopic epicardial AF ablation without LAAO was evaluated on Major adverse cardiovascular events (MACE) (HR 2.83, 95% CI 0.77-10.41, p=0.117). Surgical LAAO during thoracoscopic epicardial AF ablation in heart failure patients resulted in a MACE rate of 8.8% vs 23.1% without LAAO (HR 2.83 for non-LAAO; 95% CI 0.77-10.41; p=0.117).