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Comparative Study
. 2012 Sep;15(3):416-8.
doi: 10.1093/icvts/ivs136. Epub 2012 May 30.

Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage

Christoph T Starck  1 , Jan Steffel, Maximilian Y Emmert, Andre Plass, Srijoy Mahapatra, Volkmar Falk, Sacha P Salzberg
Affiliations
Comparative Study

Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage

Christoph T Starck et al. Interact Cardiovasc Thorac Surg. 2012 Sep.

Abstract

Objectives: The exclusion of the left atrial appendage (LAA) has been used to reduce the risk of stroke associated with atrial fibrillation (AF). While LAA exclusion has been associated with a reduced risk of stroke, the effect on the electrical activity of the LAA (a potential source of AF) remains unknown. As such, we sought to demonstrate whether surgical epicardial clip occlusion leads to the electrical isolation of the LAA.

Methods: From December 2010 until August 2011, 10 patients with paroxysmal AF underwent off-pump coronary artery bypass surgery with bilateral pulmonary vein isolation and an LAA clip occlusion with a new epicardial clip. Before and after the clip was placed, pacing manoeuvres were performed to assess the electrical exit and entry blocks from the LAA.

Results: All clips were applied successfully. The mean procedure time for the clip application was 4 ± 1 min. No complications occurred related to clip application. Prior to the pericardial closure, 18 ± 3 min after the clip placement, the LAA stimulation and pacing manoeuvres demonstrated complete electrical isolation of the LAA in all cases.

Conclusions: Epicardial LAA clip occlusion leads to the acute electrical isolation of the LAA and may not only provide stroke prevention but also reduce the recurrence of AF.

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Figures

Figure 1:
Figure 1:
The intraoperative stimulation of the LAA after the LAA clip application (1: applied LAA clip; 2: LAA; 3: pacing pen; 4: bypass grafts).
Figure 2:
Figure 2:
Pacing and sensing sites for the intraoperative testing of the electrical isolation of the LAA (1: LAA; 2: LA; 3: RV).
Figure 3:
Figure 3:
Surface and epicardial ECG during the stimulation of the LA demonstrating an entry block to the LAA.
Figure 4:
Figure 4:
Surface and epicardial ECG during the stimulation of the LAA demonstrating an exit block from the LAA.
See this image and copyright information in PMC

Comment in

References

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