TY - JOUR
T1 - Left atrial appendage
T2 - An underrecognized trigger site of atrial fibrillation
AU - Di Biase, Luigi
AU - Burkhardt, J. David
AU - Mohanty, Prasant
AU - Sanchez, Javier
AU - Mohanty, Sanghamitra
AU - Horton, Rodney
AU - Gallinghouse, G. Joseph
AU - Bailey, Shane M.
AU - Zagrodzky, Jason D.
AU - Santangeli, Pasquale
AU - Hao, Steven
AU - Hongo, Richard
AU - Beheiry, Salwa
AU - Themistoclakis, Sakis
AU - Bonso, Aldo
AU - Rossillo, Antonio
AU - Corrado, Andrea
AU - Raviele, Antonio
AU - Al-Ahmad, Amin
AU - Wang, Paul
AU - Cummings, Jennifer E.
AU - Schweikert, Robert A.
AU - Pelargonio, Gemma
AU - Dello Russo, Antonio
AU - Casella, Michela
AU - Santarelli, Pietro
AU - Lewis, William R.
AU - Natale, Andrea
PY - 2010/7/13
Y1 - 2010/7/13
N2 - Background-: Together with pulmonary veins, many extrapulmonary vein areas may be the source of initiation and maintenance of atrial fibrillation. The left atrial appendage (LAA) is an underestimated site of initiation of atrial fibrillation. Here, we report the prevalence of triggers from the LAA and the best strategy for successful ablation. Methods and results-: Nine hundred eighty-seven consecutive patients (29% paroxysmal, 71% nonparoxysmal) undergoing redo catheter ablation for atrial fibrillation were enrolled. Two hundred sixty-six patients (27%) showed firing from the LAA and became the study population. In 86 of 987 patients (8.7%; 5 paroxysmal, 81 nonparoxysmal), the LAA was found to be the only source of arrhythmia with no pulmonary veins or other extrapulmonary vein site reconnection. Ablation was performed either with focal lesion (n=56; group 2) or to achieve LAA isolation by placement of the circular catheter at the ostium of the LAA guided by intracardiac echocardiography (167 patients; group 3). In the remaining patients, LAA firing was not ablated (n=43; group 1). At the 12±3-month follow-up, 32 patients (74%) in group 1 had recurrence compared with 38 (68%) in group 2 and 25 (15%) in group 3 (P<0.001). Conclusions-: The LAA appears to be responsible for arrhythmias in 27% of patients presenting for repeat procedures. Isolation of the LAA could achieve freedom from atrial fibrillation in patients presenting for a repeat procedure when arrhythmias initiating from this structure are demonstrated.
AB - Background-: Together with pulmonary veins, many extrapulmonary vein areas may be the source of initiation and maintenance of atrial fibrillation. The left atrial appendage (LAA) is an underestimated site of initiation of atrial fibrillation. Here, we report the prevalence of triggers from the LAA and the best strategy for successful ablation. Methods and results-: Nine hundred eighty-seven consecutive patients (29% paroxysmal, 71% nonparoxysmal) undergoing redo catheter ablation for atrial fibrillation were enrolled. Two hundred sixty-six patients (27%) showed firing from the LAA and became the study population. In 86 of 987 patients (8.7%; 5 paroxysmal, 81 nonparoxysmal), the LAA was found to be the only source of arrhythmia with no pulmonary veins or other extrapulmonary vein site reconnection. Ablation was performed either with focal lesion (n=56; group 2) or to achieve LAA isolation by placement of the circular catheter at the ostium of the LAA guided by intracardiac echocardiography (167 patients; group 3). In the remaining patients, LAA firing was not ablated (n=43; group 1). At the 12±3-month follow-up, 32 patients (74%) in group 1 had recurrence compared with 38 (68%) in group 2 and 25 (15%) in group 3 (P<0.001). Conclusions-: The LAA appears to be responsible for arrhythmias in 27% of patients presenting for repeat procedures. Isolation of the LAA could achieve freedom from atrial fibrillation in patients presenting for a repeat procedure when arrhythmias initiating from this structure are demonstrated.
KW - Atrial appendage
KW - Atrial fibrillation
KW - Catheter ablation
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U2 - 10.1161/CIRCULATIONAHA.109.928903
DO - 10.1161/CIRCULATIONAHA.109.928903
M3 - Article
C2 - 20606120
AN - SCOPUS:77954757370
SN - 0009-7322
VL - 122
SP - 109
EP - 118
JO - Circulation
JF - Circulation
IS - 2
ER -