Combination of Left Atrial Appendage Isolation and Ligation to Treat Nonresponders of Pulmonary Vein Isolation

Thomas Fink*, Michael Schlüter, Christian Hendrik Heeger, Christine Lemeš, Tilman Maurer, Bruno Reissmann, Laura Rottner, Francesco Santoro, Roland Richard Tilz, Hannes Alessandrini, Andreas Rillig, Shibu Mathew, Peter Wohlmuth, Qizhi Fang, Randall Lee, Feifan Ouyang, Karl Heinz Kuck, Andreas Metzner

*Corresponding author for this work
18 Citations (Scopus)


Objectives: This study investigated the outcome of wide-area left atrial appendage isolation (WLAAI) and subsequent LAA ligation in patients with recurrent atrial arrhythmias after pulmonary vein isolation (PVI). Background: LAA isolation and ligation may improve rhythm control and prevent LAA thrombus formation in patients with atrial fibrillation who do not respond to PVI. Methods: Patients (n = 31, mean age: 69.7 ± 7.8 years, 18 men) with arrhythmia recurrence after established PVI undergoing WLAAI with subsequent LAA ligation (LARIAT+ device) were studied. The incidence of arrhythmia recurrence, intracardiac thrombus formation, thromboembolic events, as well as changes in P-wave duration and P-wave dispersion were assessed. Results: All 31 patients underwent successful WLAAI, and successful LAA ligation was performed in 27 patients (87%). Over a median follow-up of 498 (interquartile range: 159 to 791) days, post-ligation arrhythmia recurrence was documented in 8 patients (26%). Kaplan-Meier estimate of 24-month arrhythmia-free survival after WLAAI/ligation was 69.7% (95% confidence interval: 53.9 to 90.1). Following WLAAI, LAA thrombus formation was seen in 11 patients (35.5%), but in no patient after LAA ligation. WLAAI/ligation significantly reduced P-wave duration (from 93 ± 20 ms to 72 ± 20 ms; p = 0.001) and P-wave dispersion (from 63 ± 37 ms to 38 ± 16 ms; p = 0.001). Conclusions: WLAAI and subsequent LAA ligation in PVI nonresponders led to an estimated freedom from arrhythmia recurrence in 70% of the patients at 24 months. LAA ligation successfully prevented recurrence of cardiac thrombus formation in patients with WLAAI. Significant decreases in P-wave duration and P-wave dispersion occurred with WLAAI/ligation, suggesting favorable electrical remodelling.

Original languageEnglish
JournalJACC: Clinical Electrophysiology
Issue number12
Pages (from-to)1569-1579
Number of pages11
Publication statusPublished - 12.2018

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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