Benefit of left atrial appendage electrical isolation for persistent and long-standing persistent atrial fibrillation

A systematic review andmeta-analysis

Jorge E. Romero, Gregory F. Michaud, Ricardo Avendano, David F. Briceno, Saurabh Kumar, Juan Carlos Diaz, Sanghamitra Mohanty, Chintan Trivedi, Carola Gianni, Domenico Della Rocca, Riccardo Proietti, Laura Perrotta, Stefano Bordignon, Julian K.R. Chun, Boris Schmidt, Mario J. Garcia, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Aims The long-term outcomes of left atrial appendage electrical isolation (LAAEI) in patients with non-paroxysmal atrial fibrillation (AF) have corroborated the significant role of the LAA in this arrhythmia. We sought to investigate the incremental benefit of LAAEI in patients undergoing catheter ablation for persistent AF or long-standing persistent AF (LSPAF). Methods and results A systematic review of Medline, Cochrane, and Embase for all the clinical studies in which assessment LAAEI in non-paroxysmal AF patients was performed. The benefit of LAAEI in patients with AF was analysed from seven studies that enrolled a total of 930 patients [mean age 63 ± 5 years; male: 69%]. All studies included patients with either persistent AF or LSPAF or the combination of them. The overall freedom from all-arrhythmia recurrence at 12 months of follow-up off antiarrhythmic medications in patients who underwent LAAEI was 75.5% vs. 43.9% in those in whom only standard ablation was performed [56% relative reduction and 31.6% absolute reduction; risk ratio (RR) 0.44, 95% confidence interval (95% CI) 0.31-0.64; P < 0.0001]. The rate of ischaemic stroke in the LAAEI group was 0.4% and in the control group 2.1% at 12 months follow-up (RR 0.40, 95% CI 0.12-1.30; P = 0.13). Acute complications rates were identical between groups [LAAEI 5.5%, control 5.5% (RR 0.99, 95% CI 0.46-2.16; P = 0.99)]. Conclusion Left atrial appendage electrical isolation in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from ALL atrial arrhythmias in patients with persistent AF and LSPAF without increasing acute procedural complications and without raising the risk of ischaemic stroke.

Original languageEnglish (US)
Pages (from-to)1268-1278
Number of pages11
JournalEuropace
Volume20
Issue number8
DOIs
StatePublished - Jan 1 2018

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Atrial Appendage
Atrial Fibrillation
Patient Isolation
Cardiac Arrhythmias
Odds Ratio
Confidence Intervals
Stroke
Catheter Ablation
Recurrence
Control Groups

Keywords

  • Cryoablation
  • LARIAT device
  • Left trial appendage
  • Long-standing persistent atrial fibrillation
  • Meta-analysis
  • Persistent atrial fibrillation
  • Radiofrequency ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Benefit of left atrial appendage electrical isolation for persistent and long-standing persistent atrial fibrillation : A systematic review andmeta-analysis. / Romero, Jorge E.; Michaud, Gregory F.; Avendano, Ricardo; Briceno, David F.; Kumar, Saurabh; Diaz, Juan Carlos; Mohanty, Sanghamitra; Trivedi, Chintan; Gianni, Carola; Rocca, Domenico Della; Proietti, Riccardo; Perrotta, Laura; Bordignon, Stefano; Chun, Julian K.R.; Schmidt, Boris; Garcia, Mario J.; Natale, Andrea; Di Biase, Luigi.

In: Europace, Vol. 20, No. 8, 01.01.2018, p. 1268-1278.

Research output: Contribution to journalArticle

Romero, JE, Michaud, GF, Avendano, R, Briceno, DF, Kumar, S, Diaz, JC, Mohanty, S, Trivedi, C, Gianni, C, Rocca, DD, Proietti, R, Perrotta, L, Bordignon, S, Chun, JKR, Schmidt, B, Garcia, MJ, Natale, A & Di Biase, L 2018, 'Benefit of left atrial appendage electrical isolation for persistent and long-standing persistent atrial fibrillation: A systematic review andmeta-analysis', Europace, vol. 20, no. 8, pp. 1268-1278. https://doi.org/10.1093/europace/eux372
Romero, Jorge E. ; Michaud, Gregory F. ; Avendano, Ricardo ; Briceno, David F. ; Kumar, Saurabh ; Diaz, Juan Carlos ; Mohanty, Sanghamitra ; Trivedi, Chintan ; Gianni, Carola ; Rocca, Domenico Della ; Proietti, Riccardo ; Perrotta, Laura ; Bordignon, Stefano ; Chun, Julian K.R. ; Schmidt, Boris ; Garcia, Mario J. ; Natale, Andrea ; Di Biase, Luigi. / Benefit of left atrial appendage electrical isolation for persistent and long-standing persistent atrial fibrillation : A systematic review andmeta-analysis. In: Europace. 2018 ; Vol. 20, No. 8. pp. 1268-1278.
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abstract = "Aims The long-term outcomes of left atrial appendage electrical isolation (LAAEI) in patients with non-paroxysmal atrial fibrillation (AF) have corroborated the significant role of the LAA in this arrhythmia. We sought to investigate the incremental benefit of LAAEI in patients undergoing catheter ablation for persistent AF or long-standing persistent AF (LSPAF). Methods and results A systematic review of Medline, Cochrane, and Embase for all the clinical studies in which assessment LAAEI in non-paroxysmal AF patients was performed. The benefit of LAAEI in patients with AF was analysed from seven studies that enrolled a total of 930 patients [mean age 63 ± 5 years; male: 69{\%}]. All studies included patients with either persistent AF or LSPAF or the combination of them. The overall freedom from all-arrhythmia recurrence at 12 months of follow-up off antiarrhythmic medications in patients who underwent LAAEI was 75.5{\%} vs. 43.9{\%} in those in whom only standard ablation was performed [56{\%} relative reduction and 31.6{\%} absolute reduction; risk ratio (RR) 0.44, 95{\%} confidence interval (95{\%} CI) 0.31-0.64; P < 0.0001]. The rate of ischaemic stroke in the LAAEI group was 0.4{\%} and in the control group 2.1{\%} at 12 months follow-up (RR 0.40, 95{\%} CI 0.12-1.30; P = 0.13). Acute complications rates were identical between groups [LAAEI 5.5{\%}, control 5.5{\%} (RR 0.99, 95{\%} CI 0.46-2.16; P = 0.99)]. Conclusion Left atrial appendage electrical isolation in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from ALL atrial arrhythmias in patients with persistent AF and LSPAF without increasing acute procedural complications and without raising the risk of ischaemic stroke.",
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T1 - Benefit of left atrial appendage electrical isolation for persistent and long-standing persistent atrial fibrillation

T2 - A systematic review andmeta-analysis

AU - Romero, Jorge E.

AU - Michaud, Gregory F.

AU - Avendano, Ricardo

AU - Briceno, David F.

AU - Kumar, Saurabh

AU - Diaz, Juan Carlos

AU - Mohanty, Sanghamitra

AU - Trivedi, Chintan

AU - Gianni, Carola

AU - Rocca, Domenico Della

AU - Proietti, Riccardo

AU - Perrotta, Laura

AU - Bordignon, Stefano

AU - Chun, Julian K.R.

AU - Schmidt, Boris

AU - Garcia, Mario J.

AU - Natale, Andrea

AU - Di Biase, Luigi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Aims The long-term outcomes of left atrial appendage electrical isolation (LAAEI) in patients with non-paroxysmal atrial fibrillation (AF) have corroborated the significant role of the LAA in this arrhythmia. We sought to investigate the incremental benefit of LAAEI in patients undergoing catheter ablation for persistent AF or long-standing persistent AF (LSPAF). Methods and results A systematic review of Medline, Cochrane, and Embase for all the clinical studies in which assessment LAAEI in non-paroxysmal AF patients was performed. The benefit of LAAEI in patients with AF was analysed from seven studies that enrolled a total of 930 patients [mean age 63 ± 5 years; male: 69%]. All studies included patients with either persistent AF or LSPAF or the combination of them. The overall freedom from all-arrhythmia recurrence at 12 months of follow-up off antiarrhythmic medications in patients who underwent LAAEI was 75.5% vs. 43.9% in those in whom only standard ablation was performed [56% relative reduction and 31.6% absolute reduction; risk ratio (RR) 0.44, 95% confidence interval (95% CI) 0.31-0.64; P < 0.0001]. The rate of ischaemic stroke in the LAAEI group was 0.4% and in the control group 2.1% at 12 months follow-up (RR 0.40, 95% CI 0.12-1.30; P = 0.13). Acute complications rates were identical between groups [LAAEI 5.5%, control 5.5% (RR 0.99, 95% CI 0.46-2.16; P = 0.99)]. Conclusion Left atrial appendage electrical isolation in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from ALL atrial arrhythmias in patients with persistent AF and LSPAF without increasing acute procedural complications and without raising the risk of ischaemic stroke.

AB - Aims The long-term outcomes of left atrial appendage electrical isolation (LAAEI) in patients with non-paroxysmal atrial fibrillation (AF) have corroborated the significant role of the LAA in this arrhythmia. We sought to investigate the incremental benefit of LAAEI in patients undergoing catheter ablation for persistent AF or long-standing persistent AF (LSPAF). Methods and results A systematic review of Medline, Cochrane, and Embase for all the clinical studies in which assessment LAAEI in non-paroxysmal AF patients was performed. The benefit of LAAEI in patients with AF was analysed from seven studies that enrolled a total of 930 patients [mean age 63 ± 5 years; male: 69%]. All studies included patients with either persistent AF or LSPAF or the combination of them. The overall freedom from all-arrhythmia recurrence at 12 months of follow-up off antiarrhythmic medications in patients who underwent LAAEI was 75.5% vs. 43.9% in those in whom only standard ablation was performed [56% relative reduction and 31.6% absolute reduction; risk ratio (RR) 0.44, 95% confidence interval (95% CI) 0.31-0.64; P < 0.0001]. The rate of ischaemic stroke in the LAAEI group was 0.4% and in the control group 2.1% at 12 months follow-up (RR 0.40, 95% CI 0.12-1.30; P = 0.13). Acute complications rates were identical between groups [LAAEI 5.5%, control 5.5% (RR 0.99, 95% CI 0.46-2.16; P = 0.99)]. Conclusion Left atrial appendage electrical isolation in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from ALL atrial arrhythmias in patients with persistent AF and LSPAF without increasing acute procedural complications and without raising the risk of ischaemic stroke.

KW - Cryoablation

KW - LARIAT device

KW - Left trial appendage

KW - Long-standing persistent atrial fibrillation

KW - Meta-analysis

KW - Persistent atrial fibrillation

KW - Radiofrequency ablation

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