Sequential percutaneous LAA ligation and pulmonary vein isolation in patients with persistent AF: Initial results of a feasibility study

Nitish Badhwar, Dhanunjaya Lakkireddy, Mitsuharu Kawamura, Frederick T. Han, Sivaraman K. Iyer, Brian S. Moyers, Thomas Dewland, Chris Woods, Ryan Ferrell, Jayant Nath, Mathew Earnest, Randall J. Lee

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

LAA Ligation and Pulmonary Vein Isolation Introduction Left atrial appendage (LAA) ligation results in LAA electrical isolation and a decrease in atrial fibrillation (AF) burden. This study assessed the feasibility of combined percutaneous LAA ligation and pulmonary vein isolation (PVI) in patients with persistent AF. Methods and Results A total of 22 patients with persistent AF underwent LAA ligation with the LARIAT device followed by PVI. PVI was confirmed with the demonstration of both entrance and exit block. Patients (n = 10) in sinus rhythm pre- and post-LAA ligation underwent P-wave analysis. Monitoring for AF was performed at 1, 3, and 6 months postablation. LAA ligation was successful in 21 of 22 (95%) patients. The procedure was aborted in one patient due to pericardial adhesions. PVI was performed in 20 of 21 patients. One patient converted to atrial flutter with a controlled ventricular response after LAA ligation and refused subsequent PVI. Demonstration of entrance and exit block was achieved in 19 of 20 patients. At 3 months, 13 of 19 (68.4%) patients were in sinus rhythm. Four patients underwent a second PVI. At 6 months, 15 of 20 (75%) patients were in sinus rhythm. There was a significant decrease in P-wave duration and P-wave dispersion after LAA ligation. Complications with LAA ligation included pericarditis, a delayed pleural effusion, and a late pericardial effusion. Conclusions Staged LAA ligation and PVI is feasible and decreases P-wave dispersion. Randomized studies are needed to assess the efficacy of LAA ligation as adjunctive therapy to PVI for maintaining sinus rhythm in patients with persistent AF.

Original languageEnglish (US)
Pages (from-to)608-614
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume26
Issue number6
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

Fingerprint

Patient Isolation
Atrial Appendage
Pulmonary Veins
Feasibility Studies
Atrial Fibrillation
Ligation
Atrial Flutter
Pericarditis
Pericardial Effusion
Pleural Effusion

Keywords

  • atrial fibrillation
  • catheter ablation
  • LAA ligation
  • LARIAT
  • P-wave analysis
  • pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Sequential percutaneous LAA ligation and pulmonary vein isolation in patients with persistent AF : Initial results of a feasibility study. / Badhwar, Nitish; Lakkireddy, Dhanunjaya; Kawamura, Mitsuharu; Han, Frederick T.; Iyer, Sivaraman K.; Moyers, Brian S.; Dewland, Thomas; Woods, Chris; Ferrell, Ryan; Nath, Jayant; Earnest, Mathew; Lee, Randall J.

In: Journal of Cardiovascular Electrophysiology, Vol. 26, No. 6, 01.06.2015, p. 608-614.

Research output: Contribution to journalArticle

Badhwar, N, Lakkireddy, D, Kawamura, M, Han, FT, Iyer, SK, Moyers, BS, Dewland, T, Woods, C, Ferrell, R, Nath, J, Earnest, M & Lee, RJ 2015, 'Sequential percutaneous LAA ligation and pulmonary vein isolation in patients with persistent AF: Initial results of a feasibility study', Journal of Cardiovascular Electrophysiology, vol. 26, no. 6, pp. 608-614. https://doi.org/10.1111/jce.12655
Badhwar, Nitish ; Lakkireddy, Dhanunjaya ; Kawamura, Mitsuharu ; Han, Frederick T. ; Iyer, Sivaraman K. ; Moyers, Brian S. ; Dewland, Thomas ; Woods, Chris ; Ferrell, Ryan ; Nath, Jayant ; Earnest, Mathew ; Lee, Randall J. / Sequential percutaneous LAA ligation and pulmonary vein isolation in patients with persistent AF : Initial results of a feasibility study. In: Journal of Cardiovascular Electrophysiology. 2015 ; Vol. 26, No. 6. pp. 608-614.
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abstract = "LAA Ligation and Pulmonary Vein Isolation Introduction Left atrial appendage (LAA) ligation results in LAA electrical isolation and a decrease in atrial fibrillation (AF) burden. This study assessed the feasibility of combined percutaneous LAA ligation and pulmonary vein isolation (PVI) in patients with persistent AF. Methods and Results A total of 22 patients with persistent AF underwent LAA ligation with the LARIAT device followed by PVI. PVI was confirmed with the demonstration of both entrance and exit block. Patients (n = 10) in sinus rhythm pre- and post-LAA ligation underwent P-wave analysis. Monitoring for AF was performed at 1, 3, and 6 months postablation. LAA ligation was successful in 21 of 22 (95{\%}) patients. The procedure was aborted in one patient due to pericardial adhesions. PVI was performed in 20 of 21 patients. One patient converted to atrial flutter with a controlled ventricular response after LAA ligation and refused subsequent PVI. Demonstration of entrance and exit block was achieved in 19 of 20 patients. At 3 months, 13 of 19 (68.4{\%}) patients were in sinus rhythm. Four patients underwent a second PVI. At 6 months, 15 of 20 (75{\%}) patients were in sinus rhythm. There was a significant decrease in P-wave duration and P-wave dispersion after LAA ligation. Complications with LAA ligation included pericarditis, a delayed pleural effusion, and a late pericardial effusion. Conclusions Staged LAA ligation and PVI is feasible and decreases P-wave dispersion. Randomized studies are needed to assess the efficacy of LAA ligation as adjunctive therapy to PVI for maintaining sinus rhythm in patients with persistent AF.",
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T1 - Sequential percutaneous LAA ligation and pulmonary vein isolation in patients with persistent AF

T2 - Initial results of a feasibility study

AU - Badhwar, Nitish

AU - Lakkireddy, Dhanunjaya

AU - Kawamura, Mitsuharu

AU - Han, Frederick T.

AU - Iyer, Sivaraman K.

AU - Moyers, Brian S.

AU - Dewland, Thomas

AU - Woods, Chris

AU - Ferrell, Ryan

AU - Nath, Jayant

AU - Earnest, Mathew

AU - Lee, Randall J.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - LAA Ligation and Pulmonary Vein Isolation Introduction Left atrial appendage (LAA) ligation results in LAA electrical isolation and a decrease in atrial fibrillation (AF) burden. This study assessed the feasibility of combined percutaneous LAA ligation and pulmonary vein isolation (PVI) in patients with persistent AF. Methods and Results A total of 22 patients with persistent AF underwent LAA ligation with the LARIAT device followed by PVI. PVI was confirmed with the demonstration of both entrance and exit block. Patients (n = 10) in sinus rhythm pre- and post-LAA ligation underwent P-wave analysis. Monitoring for AF was performed at 1, 3, and 6 months postablation. LAA ligation was successful in 21 of 22 (95%) patients. The procedure was aborted in one patient due to pericardial adhesions. PVI was performed in 20 of 21 patients. One patient converted to atrial flutter with a controlled ventricular response after LAA ligation and refused subsequent PVI. Demonstration of entrance and exit block was achieved in 19 of 20 patients. At 3 months, 13 of 19 (68.4%) patients were in sinus rhythm. Four patients underwent a second PVI. At 6 months, 15 of 20 (75%) patients were in sinus rhythm. There was a significant decrease in P-wave duration and P-wave dispersion after LAA ligation. Complications with LAA ligation included pericarditis, a delayed pleural effusion, and a late pericardial effusion. Conclusions Staged LAA ligation and PVI is feasible and decreases P-wave dispersion. Randomized studies are needed to assess the efficacy of LAA ligation as adjunctive therapy to PVI for maintaining sinus rhythm in patients with persistent AF.

AB - LAA Ligation and Pulmonary Vein Isolation Introduction Left atrial appendage (LAA) ligation results in LAA electrical isolation and a decrease in atrial fibrillation (AF) burden. This study assessed the feasibility of combined percutaneous LAA ligation and pulmonary vein isolation (PVI) in patients with persistent AF. Methods and Results A total of 22 patients with persistent AF underwent LAA ligation with the LARIAT device followed by PVI. PVI was confirmed with the demonstration of both entrance and exit block. Patients (n = 10) in sinus rhythm pre- and post-LAA ligation underwent P-wave analysis. Monitoring for AF was performed at 1, 3, and 6 months postablation. LAA ligation was successful in 21 of 22 (95%) patients. The procedure was aborted in one patient due to pericardial adhesions. PVI was performed in 20 of 21 patients. One patient converted to atrial flutter with a controlled ventricular response after LAA ligation and refused subsequent PVI. Demonstration of entrance and exit block was achieved in 19 of 20 patients. At 3 months, 13 of 19 (68.4%) patients were in sinus rhythm. Four patients underwent a second PVI. At 6 months, 15 of 20 (75%) patients were in sinus rhythm. There was a significant decrease in P-wave duration and P-wave dispersion after LAA ligation. Complications with LAA ligation included pericarditis, a delayed pleural effusion, and a late pericardial effusion. Conclusions Staged LAA ligation and PVI is feasible and decreases P-wave dispersion. Randomized studies are needed to assess the efficacy of LAA ligation as adjunctive therapy to PVI for maintaining sinus rhythm in patients with persistent AF.

KW - atrial fibrillation

KW - catheter ablation

KW - LAA ligation

KW - LARIAT

KW - P-wave analysis

KW - pulmonary vein isolation

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