Anatomical and electrical remodeling with incomplete left atrial appendage ligation: Results from the LAALA-AF registry

Mohit Turagam, Donita Atkins, Matthew Earnest, Randall Lee, Jayant Nath, Ryan Ferrell, Krzysztof Bartus, Nitish Badhwar, Abdi Rasekh, Jie Cheng, Luigi Di Biase, Andrea Natale, David Wilber, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: The anatomical, electrical, and clinical impact of incomplete Lariat left atrial appendage ligation remains unclear. Methods: We studied LAA anatomy pre- and postligation using contrast enhanced-computed tomography (CT) scans in 91 patients with atrial fibrillation (AF) who subsequently underwent catheter ablation (CA). Results: Eleven patients had an incomplete exclusion (12%) with a central leak ranging from 1 to 5 mm. Despite incomplete ligation; the LAA volume were reduced by 67% postprocedurally when compared to preprocedure. In 7 patients with a leak between 1 and 3 mm, there was a 77% reduction in LAA volume beyond the ligation site suggestive of remodeling of the LAA. In 4 patients with larger (4-5 mm) leak the LAA remnants (LAARs) were slightly larger than those with smaller leaks on follow-up CT scan. Three out of the 4 demonstrated LAA electrical activity during CA and underwent isolation of the LAA ostium. Follow-up imaging showed two of these LAARs completely sealed with no communication with the left atrium. There was no significant difference in the AF recurrence rates between the patients who had a leak versus those with complete ligation (4 of 11 [36%] vs. 22 of 80 [27%]; P = 0.6). Oral anticoagulation was discontinued in all patients with small leaks and 2 patients with large leaks that sealed completely upon follow-up imaging. There were no strokes or TIAs at 12 months. Conclusion: Despite incomplete LAA ligation by Lariat device there is significant anatomical and electrical remodeling that resulted in reduction in LAA size, volume, and electrical activity.

Original languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - 2017
Externally publishedYes

Fingerprint

Atrial Remodeling
Atrial Appendage
Atrial Fibrillation
Ligation
Registries
Catheter Ablation
Tomography
Heart Atria
Anatomy
Stroke
Communication
Recurrence
Equipment and Supplies

Keywords

  • Atrial fibrillation
  • LAA ligation
  • Lariat
  • Left atrial appendage
  • Remodeling
  • Stroke prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Anatomical and electrical remodeling with incomplete left atrial appendage ligation : Results from the LAALA-AF registry. / Turagam, Mohit; Atkins, Donita; Earnest, Matthew; Lee, Randall; Nath, Jayant; Ferrell, Ryan; Bartus, Krzysztof; Badhwar, Nitish; Rasekh, Abdi; Cheng, Jie; Di Biase, Luigi; Natale, Andrea; Wilber, David; Lakkireddy, Dhanunjaya.

In: Journal of Cardiovascular Electrophysiology, 2017.

Research output: Contribution to journalArticle

Turagam, M, Atkins, D, Earnest, M, Lee, R, Nath, J, Ferrell, R, Bartus, K, Badhwar, N, Rasekh, A, Cheng, J, Di Biase, L, Natale, A, Wilber, D & Lakkireddy, D 2017, 'Anatomical and electrical remodeling with incomplete left atrial appendage ligation: Results from the LAALA-AF registry', Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.13343
Turagam, Mohit ; Atkins, Donita ; Earnest, Matthew ; Lee, Randall ; Nath, Jayant ; Ferrell, Ryan ; Bartus, Krzysztof ; Badhwar, Nitish ; Rasekh, Abdi ; Cheng, Jie ; Di Biase, Luigi ; Natale, Andrea ; Wilber, David ; Lakkireddy, Dhanunjaya. / Anatomical and electrical remodeling with incomplete left atrial appendage ligation : Results from the LAALA-AF registry. In: Journal of Cardiovascular Electrophysiology. 2017.
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abstract = "Background: The anatomical, electrical, and clinical impact of incomplete Lariat left atrial appendage ligation remains unclear. Methods: We studied LAA anatomy pre- and postligation using contrast enhanced-computed tomography (CT) scans in 91 patients with atrial fibrillation (AF) who subsequently underwent catheter ablation (CA). Results: Eleven patients had an incomplete exclusion (12{\%}) with a central leak ranging from 1 to 5 mm. Despite incomplete ligation; the LAA volume were reduced by 67{\%} postprocedurally when compared to preprocedure. In 7 patients with a leak between 1 and 3 mm, there was a 77{\%} reduction in LAA volume beyond the ligation site suggestive of remodeling of the LAA. In 4 patients with larger (4-5 mm) leak the LAA remnants (LAARs) were slightly larger than those with smaller leaks on follow-up CT scan. Three out of the 4 demonstrated LAA electrical activity during CA and underwent isolation of the LAA ostium. Follow-up imaging showed two of these LAARs completely sealed with no communication with the left atrium. There was no significant difference in the AF recurrence rates between the patients who had a leak versus those with complete ligation (4 of 11 [36{\%}] vs. 22 of 80 [27{\%}]; P = 0.6). Oral anticoagulation was discontinued in all patients with small leaks and 2 patients with large leaks that sealed completely upon follow-up imaging. There were no strokes or TIAs at 12 months. Conclusion: Despite incomplete LAA ligation by Lariat device there is significant anatomical and electrical remodeling that resulted in reduction in LAA size, volume, and electrical activity.",
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T1 - Anatomical and electrical remodeling with incomplete left atrial appendage ligation

T2 - Results from the LAALA-AF registry

AU - Turagam, Mohit

AU - Atkins, Donita

AU - Earnest, Matthew

AU - Lee, Randall

AU - Nath, Jayant

AU - Ferrell, Ryan

AU - Bartus, Krzysztof

AU - Badhwar, Nitish

AU - Rasekh, Abdi

AU - Cheng, Jie

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Wilber, David

AU - Lakkireddy, Dhanunjaya

PY - 2017

Y1 - 2017

N2 - Background: The anatomical, electrical, and clinical impact of incomplete Lariat left atrial appendage ligation remains unclear. Methods: We studied LAA anatomy pre- and postligation using contrast enhanced-computed tomography (CT) scans in 91 patients with atrial fibrillation (AF) who subsequently underwent catheter ablation (CA). Results: Eleven patients had an incomplete exclusion (12%) with a central leak ranging from 1 to 5 mm. Despite incomplete ligation; the LAA volume were reduced by 67% postprocedurally when compared to preprocedure. In 7 patients with a leak between 1 and 3 mm, there was a 77% reduction in LAA volume beyond the ligation site suggestive of remodeling of the LAA. In 4 patients with larger (4-5 mm) leak the LAA remnants (LAARs) were slightly larger than those with smaller leaks on follow-up CT scan. Three out of the 4 demonstrated LAA electrical activity during CA and underwent isolation of the LAA ostium. Follow-up imaging showed two of these LAARs completely sealed with no communication with the left atrium. There was no significant difference in the AF recurrence rates between the patients who had a leak versus those with complete ligation (4 of 11 [36%] vs. 22 of 80 [27%]; P = 0.6). Oral anticoagulation was discontinued in all patients with small leaks and 2 patients with large leaks that sealed completely upon follow-up imaging. There were no strokes or TIAs at 12 months. Conclusion: Despite incomplete LAA ligation by Lariat device there is significant anatomical and electrical remodeling that resulted in reduction in LAA size, volume, and electrical activity.

AB - Background: The anatomical, electrical, and clinical impact of incomplete Lariat left atrial appendage ligation remains unclear. Methods: We studied LAA anatomy pre- and postligation using contrast enhanced-computed tomography (CT) scans in 91 patients with atrial fibrillation (AF) who subsequently underwent catheter ablation (CA). Results: Eleven patients had an incomplete exclusion (12%) with a central leak ranging from 1 to 5 mm. Despite incomplete ligation; the LAA volume were reduced by 67% postprocedurally when compared to preprocedure. In 7 patients with a leak between 1 and 3 mm, there was a 77% reduction in LAA volume beyond the ligation site suggestive of remodeling of the LAA. In 4 patients with larger (4-5 mm) leak the LAA remnants (LAARs) were slightly larger than those with smaller leaks on follow-up CT scan. Three out of the 4 demonstrated LAA electrical activity during CA and underwent isolation of the LAA ostium. Follow-up imaging showed two of these LAARs completely sealed with no communication with the left atrium. There was no significant difference in the AF recurrence rates between the patients who had a leak versus those with complete ligation (4 of 11 [36%] vs. 22 of 80 [27%]; P = 0.6). Oral anticoagulation was discontinued in all patients with small leaks and 2 patients with large leaks that sealed completely upon follow-up imaging. There were no strokes or TIAs at 12 months. Conclusion: Despite incomplete LAA ligation by Lariat device there is significant anatomical and electrical remodeling that resulted in reduction in LAA size, volume, and electrical activity.

KW - Atrial fibrillation

KW - LAA ligation

KW - Lariat

KW - Left atrial appendage

KW - Remodeling

KW - Stroke prevention

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