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Review
. 2016 Feb 29;8(5):1346.
doi: 10.4022/jafib.1346. eCollection 2016 Feb-Mar.

Ablation of Atrial Fibrillation in Combination with Left Atrial Appendage Occlusion in A Single Procedure. Rationale and Technique

Ignacio García Bolao  1 , Naiara Calvo  1 , Alfonso Macias  1 , Joaquin Barba  1 , Nahikari Salterain  1 , Pablo Ramos  1 , Gabriel Ballesteros  1 , Renzo Neglia  1
Affiliations
Review

Ablation of Atrial Fibrillation in Combination with Left Atrial Appendage Occlusion in A Single Procedure. Rationale and Technique

Ignacio García Bolao et al. J Atr Fibrillation. .

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and is associated with a fivefold increase in the risk of ischemic stroke and systemic embolism. Left atrial appendage (LAA) is the source of thrombi in up to 90% of patients with nonvalvular atrial fibrillation (AF). Although thromboembolic prophylaxis by means of oral anticoagulants (OAC) has been shown to be very effective (OAC), they also confer an inevitably risk of serious bleeding. Catheter ablation (CA) is an effective treatment for symptomatic AF but its role in stroke prevention remains unproved. Recently, LAA percutaneous occlusion has been demonstrated to be equivalent to OACs in reducing thromboembolic events. The aim of this review is to describe the rationale, feasibility, outcomes and technique of a combined procedure of AFCA and percutaneous LAAO, two percutaneous interventions that share some procedural issues and technical requirements, in patients with symptomatic drug-refractory AF, high risk of stroke, and contraindications to OACs.

Keywords: Atrial Fibrillation Ablation; Left Atrial Appendage Closure; Thromboembolism.

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Figures

Figure 1.
Figure 1.. Transoesophageal echocardiography images during the combined ablation procedure and LAAO Left panel: three-dimensional TEE views after an ACP device were released Right panel: two-dimensional TEE images during the deployment of a Watchman device. Optimal position and compression was confirmed with no residual leaks and a tug test was performed demonstrating simultaneous movement of the device and LAA before releasing the device
See this image and copyright information in PMC

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