Key result
LAA electrical isolation substantially boosts arrhythmia freedom in persistent AF without increasing complications.
Why the study?
Pulmonary vein isolation has only modest efficacy in non-paroxysmal AF, and the role of left atrial appendage electrical isolation in improving outcomes is under investigation.
LAA isolation may incrementally improve arrhythmia-free survival in persistent AF; leaves open the need for randomized confirmation before practice change.
The role of pulmonary vein isolation in patients with non-paroxysmal atrial fibrillation (AF) is only modest. Several studies have demonstrated the role of the left atrial appendage (LAA) in initiating and maintaining of this arrhythmia. We review in this article the incremental benefit in free-arrhythmia recurrence of LAA electrical isolation in patients undergoing procedures for persistent AF or long standing persistent AF either using radiofrequency ablation, cryoablation or Lariat device implantation. Likewise, acute complications, anticoagulation and the risk of ischemic stroke after LAA electrical isolation (LAAEI) are analyzed. LAAEI in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from all atrial arrhythmias in patients with persistent AF and long standing persistent atrial fibrillation (LSPAF) without increasing acute procedural complications and without raising the risk of ischemic stroke.
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Romero et al. (2017) conducted a review in Persistent and long standing persistent atrial fibrillation (AF). Left atrial appendage electrical isolation (LAAEI) vs. Standard ablation was evaluated on Freedom from all atrial arrhythmias. Left atrial appendage electrical isolation added to standard ablation provides substantial benefit for achieving freedom from atrial arrhythmias in persistent AF without increasing complications.
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