Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jul 20;34(5):478-484.
doi: 10.1002/joa3.12095. eCollection 2018 Oct.

Left atrial appendage isolation in atrial fibrillation catheter ablation: A meta-analysis

Ahmed AlTurki  1 , Thao Huynh  1 , Ahmed Dawas  2 , Hussain AlTurki  3 , Jacqueline Joza  1 , Jeff S Healey  4 , Vidal Essebag  1   5
Affiliations
Review

Left atrial appendage isolation in atrial fibrillation catheter ablation: A meta-analysis

Ahmed AlTurki et al. J Arrhythm. .

Abstract

A significant proportion of patients' experience recurrence of atrial fibrillation (AF) despite pulmonary venous isolation (PVI), especially those with persistent AF. Isolation of the left atrial appendage (LAA) may reduce AF recurrence. The aim of this study was to assess the efficacy of LAA isolation in addition to PVI compared with PVI alone. We conducted a comprehensive search of electronic databases, up to April 21st, 2017, for all studies comparing the effect LAA electrical isolation or ligation in addition to PVI, as opposed to PVI alone, on the recurrence of atrial fibrillation after catheter ablation. We used random-effects meta-analysis models to summarize the studies. One RCT and four observational studies enrolling 781 patients were retained. Four studies assessed the added effect of LAA catheter ablation, and one study evaluated the effect of LAA ligation with the aim of LAA electrical isolation. Four studies exclusively enrolled patients with persistent atrial fibrillation and one study predominantly enrolled patients with persistent atrial fibrillation. Follow-up ranged from 12 to 15 months. The addition of LAA isolation to PVI reduced AF recurrence compared with the latter alone (odds ratio (OR) = 0.19; 95% confidence intervals (CI) = 0.10-0.37; P < 0.00001). Left atrial appendage isolation was also associated with a reduction in AF recurrence after repeat ablation (OR = 0.40; CI = 0.25-0.65; P = 0.0003). The addition of LAA isolation to PVI was associated with a decrease in AF recurrence in patients with persistent AF. Further studies are needed to assess the effect on long-term risk of stroke.

Keywords: atrial fibrillation; catheter ablation; left atrial appendage isolation; meta‐analysis; pulmonary vein isolation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Forest plot of recurrence events of atrial fibrillation at 12‐ to 15‐mo follow‐up comparing PVI + LAA isolation/ligation vs PVI alone. PVI, pulmonary vein isolation; LAAI, left atrial appendage isolation; OR, odds ratio; CI, confidence interval
Figure 2
Figure 2
Forest plot of recurrence of AF comparing PVI + LAA isolation/ligation vs PVI alone after repeat procedures. PVI, pulmonary vein isolation; LAAI, left atrial appendage isolation; OR, odds ratio; CI, confidence interval
Figure 3
Figure 3
Forest plots of reported thromboembolic events and all reported adverse events in PVI + LAA isolation/LAA ligation vs PVI alone. PVI, pulmonary vein isolation; LAAI, left atrial appendage isolation; OR, odds ratio; CI, confidence interval
See this image and copyright information in PMC

References

    1. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow‐up, definitions, endpoints, and research trial design. Europace. 2012;14(4):528–606. - PubMed
    1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1–76. - PubMed
    1. Verma A, Cairns JA, Mitchell LB, et al. 2014 focused update of the Canadian cardiovascular society guidelines for the management of atrial fibrillation. Can J Cardiol. 2014;30(10):1114–30. - PubMed
    1. Oral H, Knight BP, Tada H, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation. 2002;105(9):1077–81. - PubMed
    1. Ouyang F, Tilz R, Chun J, et al. Long‐term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5‐year follow‐up. Circulation. 2010;122(23):2368–77. - PubMed

LinkOut - more resources