January 1, 2020Open Access
Electrical Isolation of the Left Atrial Appendage - A New Frontier in the Treatment for Atrial Fibrillation
Key Result
Electrical isolation of the left atrial appendage, achieved via catheter ablation or closure devices, is a promising strategy to reduce the recurrence of persistent atrial fibrillation.
Structured PICO
Does electrical isolation of the left atrial appendage reduce the recurrence of atrial dysrhythmias in patients with persistent atrial fibrillation?
P
Population
Patients with atrial fibrillation, particularly the persistent form (PersAF)
I
Intervention
Electrical isolation of the left atrial appendage (LAAEI) using radiofrequency ablation, cryoballoon, Lariat device, surgical amputation, or AtriClip
C
Comparator
Standard pulmonary vein isolation (PVI) or standard ablation alone
O
Outcome
Freedom from recurrent atrial fibrillation or atrial dysrhythmias
Electrical isolation of the left atrial appendage represents a promising adjunctive therapeutic frontier for improving rhythm control in patients with persistent atrial fibrillation.
Limitations
- Lack of adequately powered, prospective, randomized studies to accurately assess outcomes.
- Radiofrequency and cryoballoon ablation are challenging techniques that carry risks of collateral damage to nearby structures.
- Complication rates related to the procedure and recovery from inserting closure devices require further inspection.
Abstract
Atrial fibrillation is not only the most common clinical arrhythmia, it is also one of the most challenging conditions to treat in day-to-day clinical practice. In particular, the persistent form of this condition is not easily amenable to traditional forms of therapy, whereas, the paroxysmal form is far more responsive to standard modes of treatment. In our relentless quest to find better solutions to overcome persistent atrial fibrillation, arguably the most promising of these currently appears to be electrical isolation of the left atrial appendage. Whilst surgical amputation of the left atrial appendage for stroke prevention has been practiced for more than half a century, only recently has attention gradually been shifting to electrical isolation of the left atrial appendage for the treatment of persistent atrial fibrillation. In this review article, we present compelling pieces of evidence for the use of this strategy, and the various ways in which it can be achieved.