The Effects of LAA Ligation on LAA Electrical Activity

Overview

Journal Heart Rhythm

Publisher Elsevier

Specialty Cardiology & Vascular Diseases

Date 2014 Jan 22

PMID 24444443

Citations 29

Authors

Frederick T Han

Krzysztof Bartus

Dhanunjaya Lakkireddy

Francia Rojas

Jacek Bednarek

Boguslaw Kapelak

Magdalena Bartus

Jerzy Sadowski

Nitish Badhwar

Mathew Earnest

Miguel Valderrabano

Randall J Lee

Affiliations

Soon will be listed here.

Abstract

Background: The arrhythmic role of the left atrial appendage (LAA) has been implicated in the maintenance of persistent atrial fibrillation. LAA isolation with catheter ablation has been successful but is limited by the risk of tamponade and electromechanical dissociation with the potential for LAA thrombus formation.

Objective: To assess whether LAA ligation results in LAA electrical isolation.

Methods: A total of 68 patients with contraindication or intolerance to oral anticoagulation therapy underwent LAA ligation with the LARIAT suture delivery device. Patients had unipolar [n = 30(44%)] or bipolar [n = 38(56%)] voltage measurements pre- and post-LAA ligation.

Results: All 68 patients underwent successful LAA ligation. There was a statistically significant reduction in the mean LAA voltage from pre-ligation (unipolar pre-ligation voltage 1.1 ± 0.53 mV; bipolar pre-ligation voltage 4.7 ± 2.83 mV) to post-ligation (unipolar post-ligation voltage 0.3 ± 0.38 mV; bipolar post-ligation voltage 0.6 ± 0.27 mV). Ninety-four percent of the patients had a reduction in the LAA voltage after the closure of the snare, with 10 of 30 (33%) of the patients having complete elimination of LAA voltage with the initial tightening of the suture. Pacing from the LAA after the closure of the snare resulted in lack of capture of the left atrium in 28 of 31 patients.

Conclusions: The snare closure of the LAA using the LARIAT device produces an acute reduction in the LAA voltage and inhibits the capture of the left atrium during LAA pacing. Future studies are needed to determine whether LAA ligation affects atrial fibrillation burden.

Citing Articles

Catheter ablation alone versus catheter ablation with combined percutaneous left atrial appendage closure for atrial fibrillation: a systematic review and meta-analysis.

Junarta J, Siddiqui M, Abaza E, Zhang P, Roshandel A, Barbhaiya C J Interv Card Electrophysiol. 2024; 67(9):2147-2158.

PMID: 39230634 DOI: 10.1007/s10840-024-01915-7.

Pulmonary Vein Isolation With or Without Left Atrial Appendage Ligation in Atrial Fibrillation: The aMAZE Randomized Clinical Trial.

Lakkireddy D, Wilber D, Mittal S, Tschopp D, Ellis C, Rasekh A JAMA. 2024; 331(13):1099-1108.

PMID: 38563835 PMC: 10988350. DOI: 10.1001/jama.2024.3026.

Hybrid Endo-Epicardial Therapies for Advanced Atrial Fibrillation.

Wong C, Buch E, Beygui R, Lee R J Clin Med. 2024; 13(3).

PMID: 38337373 PMC: 10856493. DOI: 10.3390/jcm13030679.

Research Opportunities in Stroke Prevention for Atrial Fibrillation: A Report From a National Heart, Lung, and Blood Institute Virtual Workshop.

Go A, Al-Khatib S, Desvigne-Nickens P, Bansal N, Bushnell C, Fang M Stroke. 2023; 54(3):e75-e85.

PMID: 36848427 PMC: 9995163. DOI: 10.1161/STROKEAHA.121.038273.

Simultaneous appendage ligation and atrial ablation - is it worth the risk?.

Garg J, Lakkireddy D Indian Pacing Electrophysiol J. 2021; 21(2):80-81.

PMID: 33712110 PMC: 7952887. DOI: 10.1016/j.ipej.2021.02.011.

References

Sosa E, Scanavacca M, Davila A, Pilleggi F . A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol. 1996; 7(6):531-6. DOI: 10.1111/j.1540-8167.1996.tb00559.x. View

Benussi S, Mazzone P, Maccabelli G, Vergara P, Grimaldi A, Pozzoli A . Thoracoscopic appendage exclusion with an atriclip device as a solo treatment for focal atrial tachycardia. Circulation. 2011; 123(14):1575-8. DOI: 10.1161/CIRCULATIONAHA.110.005652. View

Wang Y, Li X, Quan X, Ma J, Zhang P, Xu Y . Focal atrial tachycardia originating from the left atrial appendage: electrocardiographic and electrophysiologic characterization and long-term outcomes of radiofrequency ablation. J Cardiovasc Electrophysiol. 2007; 18(5):459-64. DOI: 10.1111/j.1540-8167.2007.00808.x. View

Tilz R, Rillig A, Thum A, Arya A, Wohlmuth P, Metzner A . Catheter ablation of long-standing persistent atrial fibrillation: 5-year outcomes of the Hamburg Sequential Ablation Strategy. J Am Coll Cardiol. 2012; 60(19):1921-9. DOI: 10.1016/j.jacc.2012.04.060. View

Di Biase L, Burkhardt J, Mohanty P, Sanchez J, Mohanty S, Horton R . Left atrial appendage: an underrecognized trigger site of atrial fibrillation. Circulation. 2010; 122(2):109-18. DOI: 10.1161/CIRCULATIONAHA.109.928903. View

McCarthy P, Gillinov A, Castle L, Chung M, Cosgrove 3rd D . The Cox-Maze procedure: the Cleveland Clinic experience. Semin Thorac Cardiovasc Surg. 2000; 12(1):25-9. DOI: 10.1016/s1043-0679(00)70013-x. View

Bruce C, Stanton C, Asirvatham S, Danielsen A, Johnson S, Packer D . Percutaneous epicardial left atrial appendage closure: intermediate-term results. J Cardiovasc Electrophysiol. 2010; 22(1):64-70. DOI: 10.1111/j.1540-8167.2010.01855.x. View

Weimar T, Schena S, Bailey M, Maniar H, Schuessler R, Cox J . The cox-maze procedure for lone atrial fibrillation: a single-center experience over 2 decades. Circ Arrhythm Electrophysiol. 2011; 5(1):8-14. PMC: 3288520. DOI: 10.1161/CIRCEP.111.963819. View

Massumi A, Chelu M, Nazeri A, May S, Afshar-Kharaghan H, Saeed M . Initial experience with a novel percutaneous left atrial appendage exclusion device in patients with atrial fibrillation, increased stroke risk, and contraindications to anticoagulation. Am J Cardiol. 2013; 111(6):869-73. DOI: 10.1016/j.amjcard.2012.11.061. View

10.

Hindricks G, Piorkowski C, Tanner H, Kobza R, Gerds-Li J, Carbucicchio C . Perception of atrial fibrillation before and after radiofrequency catheter ablation: relevance of asymptomatic arrhythmia recurrence. Circulation. 2005; 112(3):307-13. DOI: 10.1161/CIRCULATIONAHA.104.518837. View

11.

Bartus K, Morelli R, Szczepanski W, Kapelak B, Sadowski J, Lee R . Anatomic analysis of the left atrial appendage after closure with the LARIAT device. Circ Arrhythm Electrophysiol. 2014; 7(4):764-7. DOI: 10.1161/CIRCEP.113.001084. View

12.

Prasad S, Maniar H, Camillo C, Schuessler R, Boineau J, Sundt 3rd T . The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg. 2003; 126(6):1822-8. DOI: 10.1016/s0022-5223(03)01287-x. View

13.

Yang Q, Ma J, Zhang S, Hu J, Liao Z . Focal atrial tachycardia originating from the distal portion of the left atrial appendage: characteristics and long-term outcomes of radiofrequency ablation. Europace. 2011; 14(2):254-60. DOI: 10.1093/europace/eur302. View

14.

Hillock R, Singarayar S, Kalman J, Sparks P . Tale of two tails: the tip of the atrial appendages is an unusual site for focal atrial tachycardia. Heart Rhythm. 2006; 3(4):467-9. DOI: 10.1016/j.hrthm.2005.12.013. View

15.

Lee R, Bartus K, Yakubov S . Catheter-based left atrial appendage (LAA) ligation for the prevention of embolic events arising from the LAA: initial experience in a canine model. Circ Cardiovasc Interv. 2010; 3(3):224-9. DOI: 10.1161/CIRCINTERVENTIONS.109.914978. View

16.

Hocini M, Shah A, Nault I, Sanders P, Wright M, Narayan S . Localized reentry within the left atrial appendage: arrhythmogenic role in patients undergoing ablation of persistent atrial fibrillation. Heart Rhythm. 2011; 8(12):1853-61. PMC: 3393101. DOI: 10.1016/j.hrthm.2011.07.013. View

17.

Bartus K, Han F, Bednarek J, Myc J, Kapelak B, Sadowski J . Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation: initial clinical experience. J Am Coll Cardiol. 2012; 62(2):108-118. DOI: 10.1016/j.jacc.2012.06.046. View

18.

Yamada T, Murakami Y, Yoshida Y, Okada T, Yoshida N, Toyama J . Electrophysiologic and electrocardiographic characteristics and radiofrequency catheter ablation of focal atrial tachycardia originating from the left atrial appendage. Heart Rhythm. 2007; 4(10):1284-91. DOI: 10.1016/j.hrthm.2007.06.008. View

19.

Spragg D, Khurram I, Zimmerman S, Yarmohammadi H, Barcelon B, Needleman M . Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation: success and limitations. Heart Rhythm. 2012; 9(12):2003-9. DOI: 10.1016/j.hrthm.2012.08.039. View

20.

Kottkamp H, Tanner H, Kobza R, Schirdewahn P, Dorszewski A, Gerds-Li J . Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions: trigger elimination or substrate modification: early or delayed cure?. J Am Coll Cardiol. 2004; 44(4):869-77. DOI: 10.1016/j.jacc.2004.04.049. View