Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage

Luigi Di Biase, Sanghamitra Mohanty, Chintan Trivedi, Jorge E. Romero, Veronica Natale, D. Briceno, Varuna Gadiyaram, L. Couts, Carola Gianni, Amin Al-Ahmad, John David Burkhardt, G. Joseph Gallinghouse, Rodney Horton, Patrick M. Hranitzky, Javier E. Sanchez, Andrea Natale

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Loss of contractility leading to stasis of blood flow following left atrial appendage electrical isolation (LAAEI) could lead to thrombus formation. Objectives: This study evaluated the incidence of thromboembolic events (TE) in post-LAAEI cases “on” and “off” oral anticoagulation (OAC). Methods: A total of 1,854 consecutive post-LAAEI patients with follow-up transesophageal echocardiography (TEE) performed in sinus rhythm at 6 months to assess left atrial appendage (LAA) function were included in this analysis. Results: The TEE at 6 months revealed preserved LAA velocity, contractility, and consistent A waves in 336 (18%) and abnormal parameters in the remaining 1,518 patients. In the post-ablation period, all 336 patients with preserved LAA function were off OAC. At long-term follow-up, patients with normal LAA function did not experience any stroke events. Of the 1,518 patients with abnormal LAA contractility, 1,086 remained on OAC, and the incidence of stroke/transient ischemic attack (TIA) in this population was 18 of 1,086 (1.7%), whereas the number of TE events in the off-OAC patients (n = 432) was 72 (16.7%); p < 0.001. Of the 90 patients with stroke, 84 received left atrial appendage occlusion (LAAO) devices. At median 12.4 months (interquartile range: 9.8 to 15.3 months) of device implantation, 2 (2.4%) patients were on OAC because of high stroke risk or personal preference, whereas 81 patients discontinued OAC after LAAO device implantation without any TE events. Conclusions: LAAEI is associated with a significant risk of stroke that can be effectively reduced by optimal uninterrupted OAC or LAAO devices.

Original languageEnglish (US)
Pages (from-to)1019-1028
Number of pages10
JournalJournal of the American College of Cardiology
Volume74
Issue number8
DOIs
StatePublished - Aug 27 2019

Fingerprint

Atrial Appendage
Atrial Fibrillation
Stroke
Left Atrial Function
Equipment and Supplies
Transesophageal Echocardiography
Patient Isolation
Transient Ischemic Attack
Thrombosis
Cohort Studies

Keywords

  • atrial fibrillation
  • catheter ablation
  • LAA function
  • left atrial appendage electrical isolation
  • left atrial appendage occlusion
  • oral anticoagulant
  • thromboembolic events

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage. / Di Biase, Luigi; Mohanty, Sanghamitra; Trivedi, Chintan; Romero, Jorge E.; Natale, Veronica; Briceno, D.; Gadiyaram, Varuna; Couts, L.; Gianni, Carola; Al-Ahmad, Amin; Burkhardt, John David; Gallinghouse, G. Joseph; Horton, Rodney; Hranitzky, Patrick M.; Sanchez, Javier E.; Natale, Andrea.

In: Journal of the American College of Cardiology, Vol. 74, No. 8, 27.08.2019, p. 1019-1028.

Research output: Contribution to journalArticle

Di Biase, L, Mohanty, S, Trivedi, C, Romero, JE, Natale, V, Briceno, D, Gadiyaram, V, Couts, L, Gianni, C, Al-Ahmad, A, Burkhardt, JD, Gallinghouse, GJ, Horton, R, Hranitzky, PM, Sanchez, JE & Natale, A 2019, 'Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage', Journal of the American College of Cardiology, vol. 74, no. 8, pp. 1019-1028. https://doi.org/10.1016/j.jacc.2019.06.045
Di Biase, Luigi ; Mohanty, Sanghamitra ; Trivedi, Chintan ; Romero, Jorge E. ; Natale, Veronica ; Briceno, D. ; Gadiyaram, Varuna ; Couts, L. ; Gianni, Carola ; Al-Ahmad, Amin ; Burkhardt, John David ; Gallinghouse, G. Joseph ; Horton, Rodney ; Hranitzky, Patrick M. ; Sanchez, Javier E. ; Natale, Andrea. / Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage. In: Journal of the American College of Cardiology. 2019 ; Vol. 74, No. 8. pp. 1019-1028.
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title = "Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage",
abstract = "Background: Loss of contractility leading to stasis of blood flow following left atrial appendage electrical isolation (LAAEI) could lead to thrombus formation. Objectives: This study evaluated the incidence of thromboembolic events (TE) in post-LAAEI cases “on” and “off” oral anticoagulation (OAC). Methods: A total of 1,854 consecutive post-LAAEI patients with follow-up transesophageal echocardiography (TEE) performed in sinus rhythm at 6 months to assess left atrial appendage (LAA) function were included in this analysis. Results: The TEE at 6 months revealed preserved LAA velocity, contractility, and consistent A waves in 336 (18{\%}) and abnormal parameters in the remaining 1,518 patients. In the post-ablation period, all 336 patients with preserved LAA function were off OAC. At long-term follow-up, patients with normal LAA function did not experience any stroke events. Of the 1,518 patients with abnormal LAA contractility, 1,086 remained on OAC, and the incidence of stroke/transient ischemic attack (TIA) in this population was 18 of 1,086 (1.7{\%}), whereas the number of TE events in the off-OAC patients (n = 432) was 72 (16.7{\%}); p < 0.001. Of the 90 patients with stroke, 84 received left atrial appendage occlusion (LAAO) devices. At median 12.4 months (interquartile range: 9.8 to 15.3 months) of device implantation, 2 (2.4{\%}) patients were on OAC because of high stroke risk or personal preference, whereas 81 patients discontinued OAC after LAAO device implantation without any TE events. Conclusions: LAAEI is associated with a significant risk of stroke that can be effectively reduced by optimal uninterrupted OAC or LAAO devices.",
keywords = "atrial fibrillation, catheter ablation, LAA function, left atrial appendage electrical isolation, left atrial appendage occlusion, oral anticoagulant, thromboembolic events",
author = "{Di Biase}, Luigi and Sanghamitra Mohanty and Chintan Trivedi and Romero, {Jorge E.} and Veronica Natale and D. Briceno and Varuna Gadiyaram and L. Couts and Carola Gianni and Amin Al-Ahmad and Burkhardt, {John David} and Gallinghouse, {G. Joseph} and Rodney Horton and Hranitzky, {Patrick M.} and Sanchez, {Javier E.} and Andrea Natale",
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T1 - Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage

AU - Di Biase, Luigi

AU - Mohanty, Sanghamitra

AU - Trivedi, Chintan

AU - Romero, Jorge E.

AU - Natale, Veronica

AU - Briceno, D.

AU - Gadiyaram, Varuna

AU - Couts, L.

AU - Gianni, Carola

AU - Al-Ahmad, Amin

AU - Burkhardt, John David

AU - Gallinghouse, G. Joseph

AU - Horton, Rodney

AU - Hranitzky, Patrick M.

AU - Sanchez, Javier E.

AU - Natale, Andrea

PY - 2019/8/27

Y1 - 2019/8/27

N2 - Background: Loss of contractility leading to stasis of blood flow following left atrial appendage electrical isolation (LAAEI) could lead to thrombus formation. Objectives: This study evaluated the incidence of thromboembolic events (TE) in post-LAAEI cases “on” and “off” oral anticoagulation (OAC). Methods: A total of 1,854 consecutive post-LAAEI patients with follow-up transesophageal echocardiography (TEE) performed in sinus rhythm at 6 months to assess left atrial appendage (LAA) function were included in this analysis. Results: The TEE at 6 months revealed preserved LAA velocity, contractility, and consistent A waves in 336 (18%) and abnormal parameters in the remaining 1,518 patients. In the post-ablation period, all 336 patients with preserved LAA function were off OAC. At long-term follow-up, patients with normal LAA function did not experience any stroke events. Of the 1,518 patients with abnormal LAA contractility, 1,086 remained on OAC, and the incidence of stroke/transient ischemic attack (TIA) in this population was 18 of 1,086 (1.7%), whereas the number of TE events in the off-OAC patients (n = 432) was 72 (16.7%); p < 0.001. Of the 90 patients with stroke, 84 received left atrial appendage occlusion (LAAO) devices. At median 12.4 months (interquartile range: 9.8 to 15.3 months) of device implantation, 2 (2.4%) patients were on OAC because of high stroke risk or personal preference, whereas 81 patients discontinued OAC after LAAO device implantation without any TE events. Conclusions: LAAEI is associated with a significant risk of stroke that can be effectively reduced by optimal uninterrupted OAC or LAAO devices.

AB - Background: Loss of contractility leading to stasis of blood flow following left atrial appendage electrical isolation (LAAEI) could lead to thrombus formation. Objectives: This study evaluated the incidence of thromboembolic events (TE) in post-LAAEI cases “on” and “off” oral anticoagulation (OAC). Methods: A total of 1,854 consecutive post-LAAEI patients with follow-up transesophageal echocardiography (TEE) performed in sinus rhythm at 6 months to assess left atrial appendage (LAA) function were included in this analysis. Results: The TEE at 6 months revealed preserved LAA velocity, contractility, and consistent A waves in 336 (18%) and abnormal parameters in the remaining 1,518 patients. In the post-ablation period, all 336 patients with preserved LAA function were off OAC. At long-term follow-up, patients with normal LAA function did not experience any stroke events. Of the 1,518 patients with abnormal LAA contractility, 1,086 remained on OAC, and the incidence of stroke/transient ischemic attack (TIA) in this population was 18 of 1,086 (1.7%), whereas the number of TE events in the off-OAC patients (n = 432) was 72 (16.7%); p < 0.001. Of the 90 patients with stroke, 84 received left atrial appendage occlusion (LAAO) devices. At median 12.4 months (interquartile range: 9.8 to 15.3 months) of device implantation, 2 (2.4%) patients were on OAC because of high stroke risk or personal preference, whereas 81 patients discontinued OAC after LAAO device implantation without any TE events. Conclusions: LAAEI is associated with a significant risk of stroke that can be effectively reduced by optimal uninterrupted OAC or LAAO devices.

KW - atrial fibrillation

KW - catheter ablation

KW - LAA function

KW - left atrial appendage electrical isolation

KW - left atrial appendage occlusion

KW - oral anticoagulant

KW - thromboembolic events

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