Details

Autor(en) / Beteiligte

• Alipour, Arash, MD, PhD
• Swaans, Martin J., MD, PhD
• van Dijk, Vincent F., MD
• Balt, Jippe C., MD, PhD
• Post, Martijn C., MD, PhD
• Bosschaert, Mike A.R., MD
• Rensing, Benno J., MD, PhD
• Reddy, Vivek Y., MD
• Boersma, Lucas V.A., MD, PhD

Titel

Ablation for Atrial Fibrillation Combined With Left Atrial Appendage Closure

Ist Teil von

• JACC. Clinical electrophysiology, 2015-12, Vol.1 (6), p.486-495

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Abstract Objectives The study sought to determine long-term clinical effects of combining catheter ablation (CA) and left atrial appendage (LAA) occlusion (LAAO) in a single procedure. Background CA relieves symptoms in atrial fibrillation (AF), but freedom from AF is not assured. Thus, oral anticoagulation (OAC) remains necessary in high stroke risk patients. LAAO has proved a viable alternative for preventing thromboembolic complications. Methods Symptomatic patients with drug-refractory AF (CHADS2  ≥1) and indications for LAAO were included. Transesophageal echocardiography was performed to assess LAA size/anatomy/thrombus. After CA, LAAO was performed using the Watchman device (Atritech, Inc., Plymouth, Minnesota, Minnesota). At 3 months, OAC was switched to aspirin/clopidogrel if LAAO criteria were met. Results From September 2009 to October 2013, 62 patients (22 female, 64 ± 8 years of age, CHADS2 2.5) underwent combined procedures. Indications for LAAO included history of stroke despite OAC (29.0%), contraindications for OAC (24.2%), high stroke risk (24.2%), and miscellaneous reasons (22.6%). LAAO resulted in complete acute closure in all, with a median number of 1 device. After a median follow-up of 38 (range: 25 to 45) months, 95% of the patients met the criteria for successful sealing and 78% could discontinue OAC, while recurrence of AF was documented in 42%. During long-term follow-up, 3 ischemic strokes were observed with an annual stroke risk of 1.7%, which is lower than the expected annual risk of 6.5%. Conclusions LAAO combined with CA for AF can be performed successfully and safely in a single procedure, with a lower than expected stroke rate. Further studies are necessary to determine which patients benefit most from the combined therapy.