Catheter Ablation for Atrial Fibrillation in Patients With Watchman Left Atrial Appendage Occlusion Device

Results from a Multicenter Registry

Mohit K. Turagam, Madhav Lavu, Muhammad R. Afzal, Venkat Vuddanda, Mohammad Ali Jazayeri, Valay Parikh, Donita Atkins, Sudharani Bommana, Luigi Di Biase, Rodney Horton, Rong Bai, Vijay Swarup, Jie Cheng, Andrea Natale, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: There have been an increasing number of atrial fibrillation (AF) patients with Watchman left atrial appendage occlusion (LAAO) device, requiring catheter ablation (CA) for maintenance of normal sinus rhythm. In this study, we describe our experience with the feasibility and safety of CA in patients with a preexisting Watchman LAAO device. Methods: This was a retrospective multicenter AF registry of 60 patients with Watchman LAAO device who underwent CA for AF. Baseline clinical and procedural characteristics of the included subjects were retrieved from review of medical records and were analyzed. Results: The mean age was 72.7 ± 4.9 years and the mean CHADS2 score was 2.3 ± 0.6. All patients had successful pulmonary vein isolation (PVI). The left atrial appendage (LAA) was electrically active in 34 (56%) while reentrant tachycardia and AF triggers were seen in 17 (28%) patients. Electrical isolation was attempted in these 17 patients with only 10 achieving complete LAA isolation. Repeat imaging showed new peri-device leaks in 30% (12/40) patients, while new significant peri-device leaks (≥5 mm) were noted in 10% (10/40) of patients after RFA, respectively, requiring continuation of oral anticoagulation. There were a higher proportion of patients with severe peri-device leaks (≥5 mm) after LAA isolation. However, >50% of those leaks sealed off on follow-up transesophageal echocardiogram. Conclusion: AF ablation is a feasible and safe in patients with preexisting Watchman LAAO device. Electrical isolation of the LAA could be difficult and when attempted can result in increased risk of short-term peri-device leak and recurrence of AT/AF in almost all patients.

Original languageEnglish (US)
Pages (from-to)139-146
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume28
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Atrial Appendage
Catheter Ablation
Atrial Fibrillation
Registries
Equipment and Supplies
Pulmonary Veins
Tachycardia
Medical Records
Maintenance

Keywords

  • atrial fibrillation
  • catheter ablation
  • left atrial appendage exclusion
  • left atrial appendage triggers
  • pulmonary vein isolation
  • Watchman device

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Catheter Ablation for Atrial Fibrillation in Patients With Watchman Left Atrial Appendage Occlusion Device : Results from a Multicenter Registry. / Turagam, Mohit K.; Lavu, Madhav; Afzal, Muhammad R.; Vuddanda, Venkat; Jazayeri, Mohammad Ali; Parikh, Valay; Atkins, Donita; Bommana, Sudharani; Di Biase, Luigi; Horton, Rodney; Bai, Rong; Swarup, Vijay; Cheng, Jie; Natale, Andrea; Lakkireddy, Dhanunjaya.

In: Journal of Cardiovascular Electrophysiology, Vol. 28, No. 2, 01.02.2017, p. 139-146.

Research output: Contribution to journalArticle

Turagam, MK, Lavu, M, Afzal, MR, Vuddanda, V, Jazayeri, MA, Parikh, V, Atkins, D, Bommana, S, Di Biase, L, Horton, R, Bai, R, Swarup, V, Cheng, J, Natale, A & Lakkireddy, D 2017, 'Catheter Ablation for Atrial Fibrillation in Patients With Watchman Left Atrial Appendage Occlusion Device: Results from a Multicenter Registry', Journal of Cardiovascular Electrophysiology, vol. 28, no. 2, pp. 139-146. https://doi.org/10.1111/jce.13148
Turagam, Mohit K. ; Lavu, Madhav ; Afzal, Muhammad R. ; Vuddanda, Venkat ; Jazayeri, Mohammad Ali ; Parikh, Valay ; Atkins, Donita ; Bommana, Sudharani ; Di Biase, Luigi ; Horton, Rodney ; Bai, Rong ; Swarup, Vijay ; Cheng, Jie ; Natale, Andrea ; Lakkireddy, Dhanunjaya. / Catheter Ablation for Atrial Fibrillation in Patients With Watchman Left Atrial Appendage Occlusion Device : Results from a Multicenter Registry. In: Journal of Cardiovascular Electrophysiology. 2017 ; Vol. 28, No. 2. pp. 139-146.
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abstract = "Background: There have been an increasing number of atrial fibrillation (AF) patients with Watchman left atrial appendage occlusion (LAAO) device, requiring catheter ablation (CA) for maintenance of normal sinus rhythm. In this study, we describe our experience with the feasibility and safety of CA in patients with a preexisting Watchman LAAO device. Methods: This was a retrospective multicenter AF registry of 60 patients with Watchman LAAO device who underwent CA for AF. Baseline clinical and procedural characteristics of the included subjects were retrieved from review of medical records and were analyzed. Results: The mean age was 72.7 ± 4.9 years and the mean CHADS2 score was 2.3 ± 0.6. All patients had successful pulmonary vein isolation (PVI). The left atrial appendage (LAA) was electrically active in 34 (56{\%}) while reentrant tachycardia and AF triggers were seen in 17 (28{\%}) patients. Electrical isolation was attempted in these 17 patients with only 10 achieving complete LAA isolation. Repeat imaging showed new peri-device leaks in 30{\%} (12/40) patients, while new significant peri-device leaks (≥5 mm) were noted in 10{\%} (10/40) of patients after RFA, respectively, requiring continuation of oral anticoagulation. There were a higher proportion of patients with severe peri-device leaks (≥5 mm) after LAA isolation. However, >50{\%} of those leaks sealed off on follow-up transesophageal echocardiogram. Conclusion: AF ablation is a feasible and safe in patients with preexisting Watchman LAAO device. Electrical isolation of the LAA could be difficult and when attempted can result in increased risk of short-term peri-device leak and recurrence of AT/AF in almost all patients.",
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AU - Lavu, Madhav

AU - Afzal, Muhammad R.

AU - Vuddanda, Venkat

AU - Jazayeri, Mohammad Ali

AU - Parikh, Valay

AU - Atkins, Donita

AU - Bommana, Sudharani

AU - Di Biase, Luigi

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N2 - Background: There have been an increasing number of atrial fibrillation (AF) patients with Watchman left atrial appendage occlusion (LAAO) device, requiring catheter ablation (CA) for maintenance of normal sinus rhythm. In this study, we describe our experience with the feasibility and safety of CA in patients with a preexisting Watchman LAAO device. Methods: This was a retrospective multicenter AF registry of 60 patients with Watchman LAAO device who underwent CA for AF. Baseline clinical and procedural characteristics of the included subjects were retrieved from review of medical records and were analyzed. Results: The mean age was 72.7 ± 4.9 years and the mean CHADS2 score was 2.3 ± 0.6. All patients had successful pulmonary vein isolation (PVI). The left atrial appendage (LAA) was electrically active in 34 (56%) while reentrant tachycardia and AF triggers were seen in 17 (28%) patients. Electrical isolation was attempted in these 17 patients with only 10 achieving complete LAA isolation. Repeat imaging showed new peri-device leaks in 30% (12/40) patients, while new significant peri-device leaks (≥5 mm) were noted in 10% (10/40) of patients after RFA, respectively, requiring continuation of oral anticoagulation. There were a higher proportion of patients with severe peri-device leaks (≥5 mm) after LAA isolation. However, >50% of those leaks sealed off on follow-up transesophageal echocardiogram. Conclusion: AF ablation is a feasible and safe in patients with preexisting Watchman LAAO device. Electrical isolation of the LAA could be difficult and when attempted can result in increased risk of short-term peri-device leak and recurrence of AT/AF in almost all patients.

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