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Multicenter Study
. 2014 May;11(5):864-870.
doi: 10.1016/j.hrthm.2014.01.019. Epub 2014 Jan 18.

The effects of LAA ligation on LAA electrical activity

Frederick T Han #  1 , Krzysztof Bartus #  2 , Dhanunjaya Lakkireddy  3 , Francia Rojas  4 , Jacek Bednarek  5 , Boguslaw Kapelak  2 , Magdalena Bartus  6 , Jerzy Sadowski  2 , Nitish Badhwar  7 , Mathew Earnest  3 , Miguel Valderrabano  4 , Randall J Lee  7   8   9
Affiliations
Multicenter Study

The effects of LAA ligation on LAA electrical activity

Frederick T Han et al. Heart Rhythm. 2014 May.

Abstract

Background: The arrhythmic role of the left atrial appendage (LAA) has been implicated in the maintenance of persistent atrial fibrillation. LAA isolation with catheter ablation has been successful but is limited by the risk of tamponade and electromechanical dissociation with the potential for LAA thrombus formation.

Objective: To assess whether LAA ligation results in LAA electrical isolation.

Methods: A total of 68 patients with contraindication or intolerance to oral anticoagulation therapy underwent LAA ligation with the LARIAT suture delivery device. Patients had unipolar [n = 30(44%)] or bipolar [n = 38(56%)] voltage measurements pre- and post-LAA ligation.

Results: All 68 patients underwent successful LAA ligation. There was a statistically significant reduction in the mean LAA voltage from pre-ligation (unipolar pre-ligation voltage 1.1 ± 0.53 mV; bipolar pre-ligation voltage 4.7 ± 2.83 mV) to post-ligation (unipolar post-ligation voltage 0.3 ± 0.38 mV; bipolar post-ligation voltage 0.6 ± 0.27 mV). Ninety-four percent of the patients had a reduction in the LAA voltage after the closure of the snare, with 10 of 30 (33%) of the patients having complete elimination of LAA voltage with the initial tightening of the suture. Pacing from the LAA after the closure of the snare resulted in lack of capture of the left atrium in 28 of 31 patients.

Conclusions: The snare closure of the LAA using the LARIAT device produces an acute reduction in the LAA voltage and inhibits the capture of the left atrium during LAA pacing. Future studies are needed to determine whether LAA ligation affects atrial fibrillation burden.

Keywords: Atrial fibrillation; Left atrial appendage; Left atrial appendage ligation.

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Figures

Figure 1
Figure 1
(A) Mean unipolar and (B) mean bipolar left atrial appendage (LAA) voltage pre- and post-LAA closure.
Figure 2
Figure 2
Left atrial appendage (LAA) voltage recordings pre- and post-LAA closure. Pre- and post-LAA unipolar voltage recordings (A and B) from leads aVR, aVL, and aVF are displayed. Pre-ligation (C) and post-ligation (D) LAA bipolar voltage recordings.
Figure 3
Figure 3
Change in unipolar voltage and presence of atrial fibrillation on the Holter electrocardiogram.
See this image and copyright information in PMC

References

    1. Tilz RR, Rillig A, Thum AM, et al. Catheter ablation of long-standing persistent atrial fibrillation: 5-year outcomes of the Hamburg Sequential Ablation Strategy. J Am Coll Cardiol. 2012;60:1921–1929. - PubMed
    1. Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage: an underrecognized trigger site of atrial fibrillation. Circulation. 2010;122:109–118. - PubMed
    1. Hocini M, Shah AJ, Nault I, et al. Localized reentry within the left atrial appendage: arrhythmogenic role in patients undergoing ablation of persistent atrial fibrillation. Heart Rhythm. 2011;8:1853–1861. - PMC - PubMed
    1. Komahara, et al. A novel device for LAA exclusion (AtriaClip) J Thorac Cardiovasc Surg. 2005;130:16-39–16-44.
    1. Bruce CJ, Stanton CM, Asirvatham SJ, et al. Percutaneous epicardial left atrial appendage closure: intermediate-term results. J Cardiovasc Electrophysiol. 2011;22(1):64–70. - PubMed

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