Arrhythmogenecity and thrombogenecity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation

Sanghamitra Mohanty, Luigi Di Biase, Chintan Trivedi, Fahim Choudhury, Domenico G. Della Rocca, Jorge E. Romero, Carola Gianni, Javier Sanchez, Patrick Hranitzky, G. Joseph Gallinghouse, Amin Al-Ahmad, Rodney P. Horton, David Burkhardt, Andrea Natale

Research output: Contribution to journalArticle

Abstract

Introduction: It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients. Methods: Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non-PV) triggers were ablated based on operator's discretion. Results: A total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non-PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow-up, 126 (86.9%) patients from group I, eight (19.5%) from group II, and eight (33.3%) from group III remained arrhythmia-free off antiarrhythmic drugs (AAD) (P < 0.001). Sixty out of 70 patients underwent redo procedure; electrical isolation of the stump and ablation of other non-PV triggers was done in all 60 cases. At 1 year after the repeat procedure, 55 (91.7%) patients remained arrhythmia-free off-AAD. A total of four (1.88%) thromboembolic (TE) events reported, three of which were transient ischemic attacks and all three patients had “smoke” detected in the left atrium. Conclusion: LAA stump is arrhythmogenic and electrical isolation improves clinical outcome. TE events are rare and mostly associated with left atrial smoke in this subset of AF population.

Original languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Atrial Appendage
Atrial Fibrillation
Veins
Anti-Arrhythmia Agents
Smoke
Cardiac Arrhythmias
Amputation Stumps
Catheter Ablation
Transient Ischemic Attack
Heart Atria
Surgical Instruments
Recurrence

Keywords

  • left atrial appendage
  • nonpulmonary vein triggers
  • smoke
  • stroke
  • stump
  • transient ischemic attack

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Arrhythmogenecity and thrombogenecity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation. / Mohanty, Sanghamitra; Di Biase, Luigi; Trivedi, Chintan; Choudhury, Fahim; Della Rocca, Domenico G.; Romero, Jorge E.; Gianni, Carola; Sanchez, Javier; Hranitzky, Patrick; Gallinghouse, G. Joseph; Al-Ahmad, Amin; Horton, Rodney P.; Burkhardt, David; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

Mohanty, Sanghamitra ; Di Biase, Luigi ; Trivedi, Chintan ; Choudhury, Fahim ; Della Rocca, Domenico G. ; Romero, Jorge E. ; Gianni, Carola ; Sanchez, Javier ; Hranitzky, Patrick ; Gallinghouse, G. Joseph ; Al-Ahmad, Amin ; Horton, Rodney P. ; Burkhardt, David ; Natale, Andrea. / Arrhythmogenecity and thrombogenecity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation. In: Journal of Cardiovascular Electrophysiology. 2019.
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abstract = "Introduction: It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients. Methods: Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non-PV) triggers were ablated based on operator's discretion. Results: A total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non-PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow-up, 126 (86.9{\%}) patients from group I, eight (19.5{\%}) from group II, and eight (33.3{\%}) from group III remained arrhythmia-free off antiarrhythmic drugs (AAD) (P < 0.001). Sixty out of 70 patients underwent redo procedure; electrical isolation of the stump and ablation of other non-PV triggers was done in all 60 cases. At 1 year after the repeat procedure, 55 (91.7{\%}) patients remained arrhythmia-free off-AAD. A total of four (1.88{\%}) thromboembolic (TE) events reported, three of which were transient ischemic attacks and all three patients had “smoke” detected in the left atrium. Conclusion: LAA stump is arrhythmogenic and electrical isolation improves clinical outcome. TE events are rare and mostly associated with left atrial smoke in this subset of AF population.",
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T1 - Arrhythmogenecity and thrombogenecity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation

AU - Mohanty, Sanghamitra

AU - Di Biase, Luigi

AU - Trivedi, Chintan

AU - Choudhury, Fahim

AU - Della Rocca, Domenico G.

AU - Romero, Jorge E.

AU - Gianni, Carola

AU - Sanchez, Javier

AU - Hranitzky, Patrick

AU - Gallinghouse, G. Joseph

AU - Al-Ahmad, Amin

AU - Horton, Rodney P.

AU - Burkhardt, David

AU - Natale, Andrea

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N2 - Introduction: It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients. Methods: Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non-PV) triggers were ablated based on operator's discretion. Results: A total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non-PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow-up, 126 (86.9%) patients from group I, eight (19.5%) from group II, and eight (33.3%) from group III remained arrhythmia-free off antiarrhythmic drugs (AAD) (P < 0.001). Sixty out of 70 patients underwent redo procedure; electrical isolation of the stump and ablation of other non-PV triggers was done in all 60 cases. At 1 year after the repeat procedure, 55 (91.7%) patients remained arrhythmia-free off-AAD. A total of four (1.88%) thromboembolic (TE) events reported, three of which were transient ischemic attacks and all three patients had “smoke” detected in the left atrium. Conclusion: LAA stump is arrhythmogenic and electrical isolation improves clinical outcome. TE events are rare and mostly associated with left atrial smoke in this subset of AF population.

AB - Introduction: It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients. Methods: Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non-PV) triggers were ablated based on operator's discretion. Results: A total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non-PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow-up, 126 (86.9%) patients from group I, eight (19.5%) from group II, and eight (33.3%) from group III remained arrhythmia-free off antiarrhythmic drugs (AAD) (P < 0.001). Sixty out of 70 patients underwent redo procedure; electrical isolation of the stump and ablation of other non-PV triggers was done in all 60 cases. At 1 year after the repeat procedure, 55 (91.7%) patients remained arrhythmia-free off-AAD. A total of four (1.88%) thromboembolic (TE) events reported, three of which were transient ischemic attacks and all three patients had “smoke” detected in the left atrium. Conclusion: LAA stump is arrhythmogenic and electrical isolation improves clinical outcome. TE events are rare and mostly associated with left atrial smoke in this subset of AF population.

KW - left atrial appendage

KW - nonpulmonary vein triggers

KW - smoke

KW - stroke

KW - stump

KW - transient ischemic attack

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