Unexpectedly High Incidence of Stroke and Left Atrial Appendage Thrombus Formation After Electrical Isolation of the Left Atrial Appendage for the Treatment of Atrial Tachyarrhythmias

Andreas Rillig*, Roland R. Tilz, Tina Lin, Thomas Fink, Christian H. Heeger, Anita Arya, Andreas Metzner, Shibu Mathew, Erik Wissner, Hisaki Makimoto, Peter Wohlmuth, Karl Heinz Kuck, Feifan Ouyang

*Corresponding author for this work
156 Citations (Scopus)

Abstract

Background - Electric left atrial appendage (LAA) isolation (LAAI) may occur during catheter ablation of atrial tachyarrhythmias. Data regarding the risk of thromboembolic events and stroke after LAAI are sparse. This study evaluated the incidence of LAA thrombus formation and thromboembolic events after LAAI. Methods and Results - Fifty patients had LAAI (age=71 years; female=56%; CHA2DS2-VASc score before ablation =3 [2;3]). LAAI patients were compared with matched patients with comparable baseline characteristics who underwent atrial fibrillation ablation without LAAI (n=50). Ablation strategies in the LAAI group included pulmonary vein isolation in 50 (100%), left atrial isthmus line in 47 (94%), anterior line in 45 (90%), complex atrial fractionated potentials in 24 (48%), and roofline in 14 (28%) patients. Transesophageal echocardiography was performed during follow-up in 47/50 (94%) patients in the LAAI group and in all patients of the control group. Oral anticoagulation (OAC) independent of CHA2DS2-VASc score was strongly recommended in all patients. During a median follow-up of 6.5 (4-12) months, stroke occurred in 2 patients on OAC and transient ischemic attack in one without OAC in the LAAI group. In the remaining 47 patients, LAA thrombus was identified on transesophageal echocardiography in 10 (21%) patients (OAC=9; no OAC=1). In the control group, no LAA thrombus was detected and no stroke occurred (P<0.001). Stable sinus rhythm was maintained in 32 patients (64%) of the LAAI group after a median follow-up of 6.5 months (4-12), including 17/32 patients on antiarrhythmic drugs. Conclusions - After LAAI, an unexpectedly high incidence of LAA thrombus formation and stroke was observed despite OAC therapy.

Original languageEnglish
Article numbere003461
JournalCirculation: Arrhythmia and Electrophysiology
Volume9
Issue number5
ISSN1941-3149
DOIs
Publication statusPublished - 01.05.2016

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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