Left atrial appendage: An underrecognized trigger site of atrial fibrillation

Luigi Di Biase, J. David Burkhardt, Prasant Mohanty, Javier Sanchez, Sanghamitra Mohanty, Rodney Horton, G. Joseph Gallinghouse, Shane M. Bailey, Jason D. Zagrodzky, Pasquale Santangeli, Steven Hao, Richard Hongo, Salwa Beheiry, Sakis Themistoclakis, Aldo Bonso, Antonio Rossillo, Andrea Corrado, Antonio Raviele, Amin Al-Ahmad, Paul WangJennifer E. Cummings, Robert A. Schweikert, Gemma Pelargonio, Antonio Dello Russo, Michela Casella, Pietro Santarelli, William R. Lewis, Andrea Natale

Research output: Contribution to journalArticle

287 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)109-118
Number of pages10
JournalCirculation
Volume122
Issue number2
DOIs
StatePublished - Jul 13 2010
Externally publishedYes

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Atrial Appendage
Atrial Fibrillation
Cardiac Arrhythmias
Pulmonary Veins
Veins
Catheter Ablation
Echocardiography
Catheters
Maintenance
Recurrence

Keywords

  • Atrial appendage
  • Atrial fibrillation
  • Catheter ablation

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Di Biase, L., Burkhardt, J. D., Mohanty, P., Sanchez, J., Mohanty, S., Horton, R., ... Natale, A. (2010). Left atrial appendage: An underrecognized trigger site of atrial fibrillation. Circulation, 122(2), 109-118. https://doi.org/10.1161/CIRCULATIONAHA.109.928903

Left atrial appendage : An underrecognized trigger site of atrial fibrillation. / Di Biase, Luigi; Burkhardt, J. David; Mohanty, Prasant; Sanchez, Javier; Mohanty, Sanghamitra; Horton, Rodney; Gallinghouse, G. Joseph; Bailey, Shane M.; Zagrodzky, Jason D.; Santangeli, Pasquale; Hao, Steven; Hongo, Richard; Beheiry, Salwa; Themistoclakis, Sakis; Bonso, Aldo; Rossillo, Antonio; Corrado, Andrea; Raviele, Antonio; Al-Ahmad, Amin; Wang, Paul; Cummings, Jennifer E.; Schweikert, Robert A.; Pelargonio, Gemma; Dello Russo, Antonio; Casella, Michela; Santarelli, Pietro; Lewis, William R.; Natale, Andrea.

In: Circulation, Vol. 122, No. 2, 13.07.2010, p. 109-118.

Research output: Contribution to journalArticle

Di Biase, L, Burkhardt, JD, Mohanty, P, Sanchez, J, Mohanty, S, Horton, R, Gallinghouse, GJ, Bailey, SM, Zagrodzky, JD, Santangeli, P, Hao, S, Hongo, R, Beheiry, S, Themistoclakis, S, Bonso, A, Rossillo, A, Corrado, A, Raviele, A, Al-Ahmad, A, Wang, P, Cummings, JE, Schweikert, RA, Pelargonio, G, Dello Russo, A, Casella, M, Santarelli, P, Lewis, WR & Natale, A 2010, 'Left atrial appendage: An underrecognized trigger site of atrial fibrillation', Circulation, vol. 122, no. 2, pp. 109-118. https://doi.org/10.1161/CIRCULATIONAHA.109.928903
Di Biase, Luigi ; Burkhardt, J. David ; Mohanty, Prasant ; Sanchez, Javier ; Mohanty, Sanghamitra ; Horton, Rodney ; Gallinghouse, G. Joseph ; Bailey, Shane M. ; Zagrodzky, Jason D. ; Santangeli, Pasquale ; Hao, Steven ; Hongo, Richard ; Beheiry, Salwa ; Themistoclakis, Sakis ; Bonso, Aldo ; Rossillo, Antonio ; Corrado, Andrea ; Raviele, Antonio ; Al-Ahmad, Amin ; Wang, Paul ; Cummings, Jennifer E. ; Schweikert, Robert A. ; Pelargonio, Gemma ; Dello Russo, Antonio ; Casella, Michela ; Santarelli, Pietro ; Lewis, William R. ; Natale, Andrea. / Left atrial appendage : An underrecognized trigger site of atrial fibrillation. In: Circulation. 2010 ; Vol. 122, No. 2. pp. 109-118.
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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

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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.

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