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

doi:10.1016/j.jacep.2018.09.022

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

Clinic of Internal Medicine II - Cardiology

19 Citations (Scopus)

Abstract

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 language	English
Journal	JACC: Clinical Electrophysiology
Volume	4
Issue number	12
Pages (from-to)	1569-1579
Number of pages	11
ISSN	2405-500X
DOIs	https://doi.org/10.1016/j.jacep.2018.09.022
Publication status	Published - 12.2018

Funding

Drs. Fink and Heeger have received travel grants from SentreHeart. Dr. Tilz has received research grants from Medtronic and Biotronik; travel grants from Biosense Webster, Medtronic, Abbott, SentreHeart, and Daiichi Sankyo; Speakers Bureau/proctor honoraria from Biosense Webster, Medtronic, Abbott, SentreHeart, and Daiichi Sankyo; and consults for Biosense Webster and Biotronik. Dr. Rillig has received travel grants from Biosense, Hansen Medical, EP Solutions, Medtronic, and St. Jude Medical; lecture fees from St. Jude Medical, Medtronic, and Boehringer Ingelheim; and participated in the Boston Scientific EP fellowship. Dr. Mathew has received speaker honoraria and travel grants from Medtronic. Dr. Lee consults for and has equity in SentreHeart, Inc. and Apama, Inc. (Boston Scientific, Inc.). Dr. Kuck has received research grants and personal fees from St. Jude Medical, Medtronic, Biosense Webster, Boston Scientific, Abbott, and Edwards. Dr. Metzner has received speaker honoraria and travel grants from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Current affiliation for Drs. Heeger and Tilz: Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

2.22-12 Cardiology, Angiology

Access to Document

10.1016/j.jacep.2018.09.022

Cite this

Fink, T., Schlüter, M., Heeger, C. H., Lemeš, C., Maurer, T., Reissmann, B., Rottner, L., Santoro, F., Tilz, R. R., Alessandrini, H., Rillig, A., Mathew, S., Wohlmuth, P., Fang, Q., Lee, R., Ouyang, F., Kuck, K. H., & Metzner, A. (2018). Combination of Left Atrial Appendage Isolation and Ligation to Treat Nonresponders of Pulmonary Vein Isolation. JACC: Clinical Electrophysiology, 4(12), 1569-1579. https://doi.org/10.1016/j.jacep.2018.09.022

@article{85fe53d6f8bf4ef58204a80d4dec5f3b,

title = "Combination of Left Atrial Appendage Isolation and Ligation to Treat Nonresponders of Pulmonary Vein Isolation",

abstract = "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.",

author = "Thomas Fink and Michael Schl{\"u}ter and Heeger, \{Christian Hendrik\} and Christine Leme{\v s} and Tilman Maurer and Bruno Reissmann and Laura Rottner and Francesco Santoro and Tilz, \{Roland Richard\} and Hannes Alessandrini and Andreas Rillig and Shibu Mathew and Peter Wohlmuth and Qizhi Fang and Randall Lee and Feifan Ouyang and Kuck, \{Karl Heinz\} and Andreas Metzner",

note = "Publisher Copyright: {\textcopyright} 2018 American College of Cardiology Foundation",

year = "2018",

month = dec,

doi = "10.1016/j.jacep.2018.09.022",

language = "English",

volume = "4",

pages = "1569--1579",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier Inc.",

number = "12",

}

Fink, T, Schlüter, M, Heeger, CH, Lemeš, C, Maurer, T, Reissmann, B, Rottner, L, Santoro, F, Tilz, RR , Alessandrini, H, Rillig, A, Mathew, S, Wohlmuth, P, Fang, Q, Lee, R, Ouyang, F, Kuck, KH & Metzner, A 2018, 'Combination of Left Atrial Appendage Isolation and Ligation to Treat Nonresponders of Pulmonary Vein Isolation', JACC: Clinical Electrophysiology, vol. 4, no. 12, pp. 1569-1579. https://doi.org/10.1016/j.jacep.2018.09.022

TY - JOUR

T1 - Combination of Left Atrial Appendage Isolation and Ligation to Treat Nonresponders of Pulmonary Vein Isolation

AU - Fink, Thomas

AU - Schlüter, Michael

AU - Heeger, Christian Hendrik

AU - Lemeš, Christine

AU - Maurer, Tilman

AU - Reissmann, Bruno

AU - Rottner, Laura

AU - Santoro, Francesco

AU - Tilz, Roland Richard

AU - Alessandrini, Hannes

AU - Rillig, Andreas

AU - Mathew, Shibu

AU - Wohlmuth, Peter

AU - Fang, Qizhi

AU - Lee, Randall

AU - Ouyang, Feifan

AU - Kuck, Karl Heinz

AU - Metzner, Andreas

PY - 2018/12

Y1 - 2018/12

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85058059175

U2 - 10.1016/j.jacep.2018.09.022

DO - 10.1016/j.jacep.2018.09.022

M3 - Journal articles

C2 - 30573121

AN - SCOPUS:85058059175

SN - 2405-500X

VL - 4

SP - 1569

EP - 1579

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

IS - 12

ER -

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

Abstract

Funding

UN SDGs

Research Areas and Centers

DFG Research Classification Scheme

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