March 14, 2015
View Full PaperSequential Percutaneous LAA Ligation and Pulmonary Vein Isolation in Patients with Persistent AF: Initial Results of a Feasibility Study
Key Result
Sequential percutaneous LAA ligation and pulmonary vein isolation was feasible, with 75% of patients maintaining sinus rhythm at 6 months.
Study Design
Type
Observational (n=22)
Structured PICO
Is combined percutaneous LAA ligation and pulmonary vein isolation feasible and effective for maintaining sinus rhythm in patients with persistent AF?
P
Population
22 patients with persistent atrial fibrillation undergoing sequential percutaneous LAA ligation and pulmonary vein isolation, followed for 6 months.
I
Intervention
Percutaneous left atrial appendage (LAA) ligation with the LARIAT device followed by pulmonary vein isolation (PVI)
O
Outcome
Feasibility of the combined procedure and maintenance of sinus rhythm at 3 and 6 months postablationsurrogate
Staged percutaneous LAA ligation and pulmonary vein isolation is feasible and may help maintain sinus rhythm in patients with persistent atrial fibrillation.
Abstract
INTRODUCTION: Left atrial appendage (LAA) ligation results in LAA electrical isolation and a decrease in atrial fibrillation (AF) burden. This study assessed the feasibility of combined percutaneous LAA ligation and pulmonary vein isolation (PVI) in patients with persistent AF. METHODS AND RESULTS: A total of 22 patients with persistent AF underwent LAA ligation with the LARIAT device followed by PVI. PVI was confirmed with the demonstration of both entrance and exit block. Patients (n = 10) in sinus rhythm pre- and post-LAA ligation underwent P-wave analysis. Monitoring for AF was performed at 1, 3, and 6 months postablation. LAA ligation was successful in 21 of 22 (95%) patients. The procedure was aborted in one patient due to pericardial adhesions. PVI was performed in 20 of 21 patients. One patient converted to atrial flutter with a controlled ventricular response after LAA ligation and refused subsequent PVI. Demonstration of entrance and exit block was achieved in 19 of 20 patients. At 3 months, 13 of 19 (68.4%) patients were in sinus rhythm. Four patients underwent a second PVI. At 6 months, 15 of 20 (75%) patients were in sinus rhythm. There was a significant decrease in P-wave duration and P-wave dispersion after LAA ligation. Complications with LAA ligation included pericarditis, a delayed pleural effusion, and a late pericardial effusion. CONCLUSIONS: Staged LAA ligation and PVI is feasible and decreases P-wave dispersion. Randomized studies are needed to assess the efficacy of LAA ligation as adjunctive therapy to PVI for maintaining sinus rhythm in patients with persistent AF.