Catheter ablation for atrial fibrillation in patients with prior left atrial appendage occlusion device

IF 2.1 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Interventional Cardiac Electrophysiology Pub Date : 2024-09-11 DOI:10.1007/s10840-024-01914-8

Jakrin Kewcharoen, Kuldeep Shah, Rahul Bhardwaj, Tahmeed Contractor, Davendra Ramsingh, Mohit K. Turagam, Ravi Mandapati, Dhanunjaya Lakkireddy, Jalaj Garg

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Abstract

Background

The safety and efficacy of CA for AF and left-sided atrial arrhythmias (AA) in patients with left atrial appendage occlusion (LAAO) devices are lacking.

Methods

This is a single-center retrospective registry that included all patients with prior LAAO who underwent catheter ablation for AF or left-sided atrial arrhythmia from January 2020–January 2023. The primary outcomes were procedure-related complications, device-related complications, AA recurrence, and stroke.

Results

A total of 30 patients with prior LAAO were included in the analysis (mean age 75.1 ± 7.1 years old, 50% male, mean CHA₂DS₂-VASc score 4 ± 1.6, 46.7% paroxysmal AF, 73.3% had prior AF ablation, mean time to ablation 475 ± 365 days). 93.3% (n = 28) and 6.6% (n = 2) patients had ablation for AF (46.7% paroxysmal, 36.7% persistent, 10% long-standing persistent) and left-sided atrial tachycardia, respectively. 16.7% (n = 5) patients underwent ablation along the left atrial appendage ostium, and 3.3% (n = 1) underwent Vein of Marshall alcohol ablation. There were 3 (10%) peri-procedural complications (1 access hematoma and two pericardial effusions requiring intervention—none related to left atrial appendage ostium or alcohol ablation). During the mean follow-up of 440 ± 379 days, 40% (n = 12) patients had AA recurrence (91.6% AF, 8.3% atrial tachycardia), of which five patients needed repeat ablation, and two patients were readmitted for heart failure. There was no stroke or any device-related complications, including new peri-device leaks or device-related thrombosis in patients who had follow-up imaging studies (n = 11, 36.7%).

Conclusion

Catheter ablation for AF (including VoM alcohol ablation) in patients with prior LAAO devices is feasible and safe with favorable outcomes.

Graphical Abstract

Abstract Image

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曾使用左房阑尾闭塞器的患者心房颤动的导管消融术

背景目前尚缺乏对使用左心房阑尾闭塞（LAAO）装置的房颤和左侧房性心律失常（AA）患者进行CA治疗的安全性和有效性研究。方法这是一项单中心回顾性登记，纳入了2020年1月至2023年1月期间所有因房颤或左侧房性心律失常而接受导管消融术的既往LAAO患者。结果共有 30 名既往 LAAO 患者纳入分析（平均年龄为 75.1 ± 7.1 岁，50% 为男性，平均 CHA2DS2-VASc 评分为 4 ± 1.6，46.7% 为阵发性房颤，73.3% 曾接受房颤消融术，平均消融时间为 475 ± 365 天）。93.3%（28 人）和 6.6%（2 人）的患者分别因阵发性房颤（46.7% 阵发性、36.7% 持续性、10% 长期持续性）和左侧房性心动过速而进行了消融术。16.7%（5 人）的患者接受了沿左心房附壁的消融术，3.3%（1 人）的患者接受了马歇尔静脉酒精消融术。有 3 例（10%）围手术期并发症（1 例入路血肿和 2 例需要介入治疗的心包积液，均与左心房阑尾骨膜或酒精消融无关）。在平均 440 ± 379 天的随访期间，40%（n = 12）的患者出现房颤复发（91.6% 为房颤，8.3% 为房性心动过速），其中 5 名患者需要再次消融，2 名患者因心力衰竭再次入院。在接受随访影像学检查的患者（11 人，36.7%）中，没有发生中风或任何与设备相关的并发症，包括新的设备周围渗漏或与设备相关的血栓。

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来源期刊

Journal of Interventional Cardiac Electrophysiology 医学-心血管系统

CiteScore

4.30

自引率

11.10%

发文量

320

审稿时长

4-8 weeks

期刊介绍： The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.