Impact of left atrial appendage exclusion using an epicardial ligation system (LARIAT) on atrial fibrillation burden in patients with cardiac implantable electronic devices

Muhammad R. Afzal, Arun Kanmanthareddy, Matthew Earnest, Madhu Reddy, Donita Atkins, Sudharani Bommana, Krystof Bartus, Abdi Rasekh, Fred Han, Nitish Badhwar, Jie Cheng, Luigi Di Biase, Christopher R. Ellis, Buddhadeb Dawn, Andrea Natale, Randall J. Lee, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

BACKGROUND: The left atrial appendage (LAA) is a well-known source of atrial arrhythmia and atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to determine whether LAA exclusion using the LARIAT device would decrease AF burden. METHODS: A total of 50 patients with AF and cardiac implantable electronic devices who underwent successful LAA exclusion were enrolled in this prospective observational study. AF burden before LAA exclusion (baseline) and 3 and 12 months after exclusion was assessed by device interrogation. RESULTS: AF burden at 3-month follow-up (42% ± 34%) was significantly lower compared to baseline (76% ± 33%, P < .0001). The reduction in AF burden was sustained at 12 months (59% ± 26%, P < .001). Subgroup analysis revealed that AF burden at 3-month follow-up was similarly reduced in both paroxysmal AF (n = 19) and nonparoxysmal AF (n = 31). However, there was no reduction in AF burden in patients with paroxysmal AF at 12 months. AF burden in patients with known AF triggers in the LAA (n = 9) was significantly reduced at 3 months (52% ± 35%) and 12 months (42% ± 19%) compared to respective baseline (84 ± 31%, P < .0001). CONCLUSION: LAA exclusion appears to reduce AF burden. The presence of AF triggers in the LAA appears to be the strongest predictor of AF reduction. The study underscores the role of the LAA in arrhythmogenesis for AF and highlights the complementary role of LAA exclusion in restoration of normal sinus rhythm.

Original languageEnglish (US)
Pages (from-to)52-59
Number of pages8
JournalHeart Rhythm
Volume12
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Atrial Appendage
Atrial Fibrillation
Ligation
Equipment and Supplies

Keywords

  • Atrial fibrillation
  • Left atrial appendage
  • Pericarditis
  • Suture exclusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Impact of left atrial appendage exclusion using an epicardial ligation system (LARIAT) on atrial fibrillation burden in patients with cardiac implantable electronic devices. / Afzal, Muhammad R.; Kanmanthareddy, Arun; Earnest, Matthew; Reddy, Madhu; Atkins, Donita; Bommana, Sudharani; Bartus, Krystof; Rasekh, Abdi; Han, Fred; Badhwar, Nitish; Cheng, Jie; Di Biase, Luigi; Ellis, Christopher R.; Dawn, Buddhadeb; Natale, Andrea; Lee, Randall J.; Lakkireddy, Dhanunjaya.

In: Heart Rhythm, Vol. 12, No. 1, 01.01.2015, p. 52-59.

Research output: Contribution to journalArticle

Afzal, MR, Kanmanthareddy, A, Earnest, M, Reddy, M, Atkins, D, Bommana, S, Bartus, K, Rasekh, A, Han, F, Badhwar, N, Cheng, J, Di Biase, L, Ellis, CR, Dawn, B, Natale, A, Lee, RJ & Lakkireddy, D 2015, 'Impact of left atrial appendage exclusion using an epicardial ligation system (LARIAT) on atrial fibrillation burden in patients with cardiac implantable electronic devices', Heart Rhythm, vol. 12, no. 1, pp. 52-59. https://doi.org/10.1016/j.hrthm.2014.09.053
Afzal, Muhammad R. ; Kanmanthareddy, Arun ; Earnest, Matthew ; Reddy, Madhu ; Atkins, Donita ; Bommana, Sudharani ; Bartus, Krystof ; Rasekh, Abdi ; Han, Fred ; Badhwar, Nitish ; Cheng, Jie ; Di Biase, Luigi ; Ellis, Christopher R. ; Dawn, Buddhadeb ; Natale, Andrea ; Lee, Randall J. ; Lakkireddy, Dhanunjaya. / Impact of left atrial appendage exclusion using an epicardial ligation system (LARIAT) on atrial fibrillation burden in patients with cardiac implantable electronic devices. In: Heart Rhythm. 2015 ; Vol. 12, No. 1. pp. 52-59.
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abstract = "BACKGROUND: The left atrial appendage (LAA) is a well-known source of atrial arrhythmia and atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to determine whether LAA exclusion using the LARIAT device would decrease AF burden. METHODS: A total of 50 patients with AF and cardiac implantable electronic devices who underwent successful LAA exclusion were enrolled in this prospective observational study. AF burden before LAA exclusion (baseline) and 3 and 12 months after exclusion was assessed by device interrogation. RESULTS: AF burden at 3-month follow-up (42{\%} ± 34{\%}) was significantly lower compared to baseline (76{\%} ± 33{\%}, P < .0001). The reduction in AF burden was sustained at 12 months (59{\%} ± 26{\%}, P < .001). Subgroup analysis revealed that AF burden at 3-month follow-up was similarly reduced in both paroxysmal AF (n = 19) and nonparoxysmal AF (n = 31). However, there was no reduction in AF burden in patients with paroxysmal AF at 12 months. AF burden in patients with known AF triggers in the LAA (n = 9) was significantly reduced at 3 months (52{\%} ± 35{\%}) and 12 months (42{\%} ± 19{\%}) compared to respective baseline (84 ± 31{\%}, P < .0001). CONCLUSION: LAA exclusion appears to reduce AF burden. The presence of AF triggers in the LAA appears to be the strongest predictor of AF reduction. The study underscores the role of the LAA in arrhythmogenesis for AF and highlights the complementary role of LAA exclusion in restoration of normal sinus rhythm.",
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T1 - Impact of left atrial appendage exclusion using an epicardial ligation system (LARIAT) on atrial fibrillation burden in patients with cardiac implantable electronic devices

AU - Afzal, Muhammad R.

AU - Kanmanthareddy, Arun

AU - Earnest, Matthew

AU - Reddy, Madhu

AU - Atkins, Donita

AU - Bommana, Sudharani

AU - Bartus, Krystof

AU - Rasekh, Abdi

AU - Han, Fred

AU - Badhwar, Nitish

AU - Cheng, Jie

AU - Di Biase, Luigi

AU - Ellis, Christopher R.

AU - Dawn, Buddhadeb

AU - Natale, Andrea

AU - Lee, Randall J.

AU - Lakkireddy, Dhanunjaya

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND: The left atrial appendage (LAA) is a well-known source of atrial arrhythmia and atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to determine whether LAA exclusion using the LARIAT device would decrease AF burden. METHODS: A total of 50 patients with AF and cardiac implantable electronic devices who underwent successful LAA exclusion were enrolled in this prospective observational study. AF burden before LAA exclusion (baseline) and 3 and 12 months after exclusion was assessed by device interrogation. RESULTS: AF burden at 3-month follow-up (42% ± 34%) was significantly lower compared to baseline (76% ± 33%, P < .0001). The reduction in AF burden was sustained at 12 months (59% ± 26%, P < .001). Subgroup analysis revealed that AF burden at 3-month follow-up was similarly reduced in both paroxysmal AF (n = 19) and nonparoxysmal AF (n = 31). However, there was no reduction in AF burden in patients with paroxysmal AF at 12 months. AF burden in patients with known AF triggers in the LAA (n = 9) was significantly reduced at 3 months (52% ± 35%) and 12 months (42% ± 19%) compared to respective baseline (84 ± 31%, P < .0001). CONCLUSION: LAA exclusion appears to reduce AF burden. The presence of AF triggers in the LAA appears to be the strongest predictor of AF reduction. The study underscores the role of the LAA in arrhythmogenesis for AF and highlights the complementary role of LAA exclusion in restoration of normal sinus rhythm.

AB - BACKGROUND: The left atrial appendage (LAA) is a well-known source of atrial arrhythmia and atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to determine whether LAA exclusion using the LARIAT device would decrease AF burden. METHODS: A total of 50 patients with AF and cardiac implantable electronic devices who underwent successful LAA exclusion were enrolled in this prospective observational study. AF burden before LAA exclusion (baseline) and 3 and 12 months after exclusion was assessed by device interrogation. RESULTS: AF burden at 3-month follow-up (42% ± 34%) was significantly lower compared to baseline (76% ± 33%, P < .0001). The reduction in AF burden was sustained at 12 months (59% ± 26%, P < .001). Subgroup analysis revealed that AF burden at 3-month follow-up was similarly reduced in both paroxysmal AF (n = 19) and nonparoxysmal AF (n = 31). However, there was no reduction in AF burden in patients with paroxysmal AF at 12 months. AF burden in patients with known AF triggers in the LAA (n = 9) was significantly reduced at 3 months (52% ± 35%) and 12 months (42% ± 19%) compared to respective baseline (84 ± 31%, P < .0001). CONCLUSION: LAA exclusion appears to reduce AF burden. The presence of AF triggers in the LAA appears to be the strongest predictor of AF reduction. The study underscores the role of the LAA in arrhythmogenesis for AF and highlights the complementary role of LAA exclusion in restoration of normal sinus rhythm.

KW - Atrial fibrillation

KW - Left atrial appendage

KW - Pericarditis

KW - Suture exclusion

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