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. 2022 May 31;11(11):3110.
doi: 10.3390/jcm11113110.

Safety and Efficacy of Left Atrial Catheter Ablation in Patients with Left Atrial Appendage Occlusion Devices

Binhao Wang  1 , Bin He  1 , Guohua Fu  1 , Mingjun Feng  1 , Xianfeng Du  1 , Jing Liu  1 , Yibo Yu  1 , Huimin Chu  1
Affiliations

Safety and Efficacy of Left Atrial Catheter Ablation in Patients with Left Atrial Appendage Occlusion Devices

Binhao Wang et al. J Clin Med. .

Abstract

Background: Left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulation for thromboembolic prevention in patients with atrial fibrillation (AF). Left atrial (LA) catheter ablation (CA) in patients with LAAO devices has not been well investigated. Here, we report on the safety and efficacy of LA CA in patients with nitinol cage or plug LAAO devices.

Methods: A total of 18 patients (aged 67 ± 11 years; 14 males; 5 paroxysmal AF) with LAAO devices (nitinol cage, n = 10; nitinol plug, n = 8) and symptomatic LA tachyarrhythmias were included. Periprocedural and follow-up data were assessed.

Results: A total of 20 LA CA procedures were performed at a median of 130 (63, 338) days after LAAO. The strategy of CA consisted of circumferential pulmonary vein isolation (n = 16), linear lesions (n = 14) and complex fractionated atrial electrogram ablation (n = 6). No major adverse events occurred periprocedurally. Repeated transesophageal echocardiography showed no device-related thrombus, newly developed peridevice leakage or device dislodgement. After a median follow-up period of 793 (376, 1090) days, four patients (22%) experienced LA tachyarrhythmias recurrence and two received redo LA CA. No patients suffered stroke or major bleeding events during follow-up.

Conclusions: LA CA in patients with LAAO devices (either nitinol cages or nitinol plugs) seems to be safe and efficient in our single-center experience.

Keywords: atrial fibrillation; catheter ablation; left atrial appendage occlusion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The LA CA procedure (index and redo) and TEE follow-up in a patient with an implanted LAAO device. (a) Fluoroscopic image showed the position of Watchman device (white arrow), coronary sinus catheter (green arrow), circular mapping catheter (yellow arrow) and ablation catheter (red arrow); (b) during the index procedure for paroxysmal AF, CPVI was successfully performed; (c) during the redo procedure for AFL, the ridge between the LAA and left superior PV were targeted (red dots) to restore sinus rhythm; (d–f) TEE follow-up after LA CA showed no device dislodgement, PDL, or DRT. AF—atrial fibrillation; AFL—atrial flutter; CA—catheter ablation; CPVI—circumferential pulmonary vein isolation; DRT—device-related thrombus; LA—left atrium; LAAO—left atrial appendage occlusion; PDL—peridevice leakage; PV—pulmonary vein.
Figure 1
Figure 1
The LA CA procedure (index and redo) and TEE follow-up in a patient with an implanted LAAO device. (a) Fluoroscopic image showed the position of Watchman device (white arrow), coronary sinus catheter (green arrow), circular mapping catheter (yellow arrow) and ablation catheter (red arrow); (b) during the index procedure for paroxysmal AF, CPVI was successfully performed; (c) during the redo procedure for AFL, the ridge between the LAA and left superior PV were targeted (red dots) to restore sinus rhythm; (d–f) TEE follow-up after LA CA showed no device dislodgement, PDL, or DRT. AF—atrial fibrillation; AFL—atrial flutter; CA—catheter ablation; CPVI—circumferential pulmonary vein isolation; DRT—device-related thrombus; LA—left atrium; LAAO—left atrial appendage occlusion; PDL—peridevice leakage; PV—pulmonary vein.
Figure 2
Figure 2
Kaplan–Meier cumulative event-free curves of LA tachyarrhythmias. (a) Total study population; (b) nitinol cage vs. nitinol plug. LA—left atrium.
See this image and copyright information in PMC

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