Effects on antiarrhythmic and anticoagulation therapy after concomitant epicardial left atrial ablation procedure - one year results

Objective Left atrial appendage (LAA) plays a crucial role in the etiopathogenesis and the prevention of the stroke in patients with nonvalvular atrial fibrillation (AF). This paper presents our first experience with thoracoscopic LAA occlusion using an external clip. Methods We performed a total of 30 LAA occlusions with the AtriClip from left thoracoscopy approach during the period from July 2012 to July 2013. AtriClip was implanted during the bilateral thoracoscopic radiofrequency (RF) as part of left atrial ablation procedure. Results Among the 30 procedures, AtriClip was once periprocedurally partially positioned. In the remaining procedures, the implantation was successful without complications. Of the 30 patients, 29 underwent transesophageal echocardiography and computer tomography examination at 3 months after the procedure. Apart from the patient with the partial clip placement, a residual pouch of 18 mm was detected in another patient. In the remaining group (28/30 patients, 93%), the exclusion was complete. No migration or any other clip implantation-related complications occurred during the follow-up. None of the patients experienced an embolization event. Conclusions Endoscopic AtriClip implantation appears to be a reproducible and safe method of LAA occlusion, with a minimal risk and a high efficiency. In our opinion, the AtriClip implantation is a reasonable part of thoracoscopic AF treatment and should be considered as an alternative tool for stroke risk reduction in patients with AF.

Download Full-text

Faculty Opinions recommendation of Interatrial septal puncture without the use of fluoroscopy-reducing ionizing radiation in left atrial ablation procedures.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1119287.572452 ◽

2008 ◽

Author(s):

Heather Bloom

Keyword(s):

Ionizing Radiation ◽

Left Atrial ◽

Atrial Ablation

Download Full-text

Consideration of non-valvular atrial fibrillation with left atrial appendage thrombus formation despite under appropriate oral anticoagulation therapy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0071 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Shiraki ◽

H Tanaka ◽

K Yamashita ◽

Y Tanaka ◽

K Sumimoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Regression Analysis ◽

Oral Anticoagulation ◽

Left Atrial ◽

Thrombus Formation ◽

Anticoagulation Therapy ◽

Left Ventricular ◽

Volume Index ◽

Oral Anticoagulation Therapy

Abstract Background Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia, with a prevalence of about 2–3% in the general population. In accordance with CHADS2 or CHA2DS2-VASc score, appropriate oral anticoagulation therapy such as warfarin or direct oral anticoagulants (DOAC) significantly reduced the risk of thromboembolic events. However, left atrial (LA) thrombus can be detected in the LA appendage (LAA) in AF patients despite appropriate oral anticoagulation therapy. Purpose Our purpose was to investigate the associated factors of LAA thrombus formation in non-valvular atrial fibrillation (NVAF) patients despite under appropriate oral anticoagulation therapy. Methods We retrospectively studied consecutive 286 NVAF patients for scheduled catheter ablation or electrical cardioversion for AF in our institution between February 2017 and September 2019. Mean age was 67.1±9.4 years, 79 patients (29.5%) were female, and 140 (52.2%) were paroxysmal AF. All patients underwent transthoracic and transesophageal echocardiography before catheter ablation or electrical cardioversion. All patients received appropriate oral anticoagulation therapy including warfarin or DOAC for at least 3 weeks prior to transesophageal echocardiography based on the current guidelines. LAA thrombus was defined as an echodense intracavitary mass distinct from the underlying endocardium and not caused by pectinate muscles by at least three senior echocardiologists. Results Of 286 NVAF patients with under appropriate oral anticoagulation therapy, LAA thrombus was observed in 9 patients (3.3%). Univariate logistic regression analysis showed that age, paroxysmal AF, CHADS2 score ≥3, left ventricular end-diastolic volume index (LVEDVI), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), LA volume index (LAVI), mitral inflow E and mitral e' annular velocities ratio (E/e'), and LAA flow were associated with LAA thrombus formation. It was noteworthy that multivariate logistic regression analysis showed that LAA flow was independent predictor of LAA thrombus (OR: 0.72, 95% CI: 0.59–0.89, p<0.005) as well as LVEF. Furthermore, receiver operating characteristic (ROC) curve analysis identified the optimal cutoff value of LAA flow for predicting LAA thrombus as ≤15cm/s, with a sensitivity of 88%, specificity of 93%, and area under the curve (AUC) of 0.95. Conclusions LAA flow was strongly associated with LAA thrombus formation even in NVAF patients with appropriate oral anticoagulation therapy. According to our findings, further strengthen of oral anticoagulation therapy or percutaneous transcatheter closure of the LAA may be considered in NVAF patients with appropriate oral anticoagulation therapy but low LAA flow, especially <15cm/s. Funding Acknowledgement Type of funding source: None

Download Full-text

Transseptal Access for Left Atrial Ablation: The Catheter-Probing Techniques Are Not Without Risk

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.12356 ◽

2014 ◽

Vol 25 (5) ◽

pp. 479-484 ◽

Cited By ~ 16

Author(s):

HEIKO LEHRMANN ◽

JENS SCHNEIDER ◽

AMIR S. JADIDI ◽

CHAN-IL PARK ◽

JOCHEN SCHIEBELING-RÖMER ◽

...

Keyword(s):

Left Atrial ◽

Atrial Ablation

Download Full-text

Clinical outcome of left atrial ablation for paroxysmal atrial fibrillation is related to the extent of radiofrequency ablation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-008-9247-9 ◽

2008 ◽

Vol 22 (1) ◽

pp. 31-37 ◽

Cited By ~ 12

Author(s):

Demosthenes Katritsis ◽

Kenneth A. Ellenbogen ◽

Eleftherios Giazitzoglou ◽

Dimitrios Sougiannis ◽

George Paxinos ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Clinical Outcome ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Atrial Ablation

Download Full-text

Abstract 12707: Chads2 and Chads2vasc Scores Predict the Risk for Left Atrial Thrombus in Patients With Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.12707 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Fengpeng Jia ◽

Minghuan Fu ◽

Zhiyu Ling ◽

Suxin Luo ◽

Jun Gu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Strong Association ◽

Anticoagulation Therapy ◽

Scoring Systems ◽

Left Atrial Thrombus ◽

Atrial Thrombus ◽

Chads2 Score ◽

Risk Patients ◽

The Relationship

Background: The study was to evaluate the value of CHADS2 and CHADS2VASC scores on predicting left atrial (LA) thrombus in the patients with atrial fibrillation (AF). Methods and Results: All the non-valvular AF patients undergoing AF ablation from June 2010 to June 2012 were included and divided into two groups: patients without anticoagulation and with Coumadin anticoagulation for at least 4 weeks. The relationship between CHADS2 and CHADS2VASC scores and LA thrombus as identified on transesophageal echocardiography (TEE) was analyzed prior to ablation. A total of 397 patients underwent pre-ablation TEE: 212 patients without anticoagulation, and 185 with anticoagulation. There were no differences in the CHADS2 and CHADS2VASC scores in the two groups. LA thrombus was present in 15.6% and 5.9% for the patients without anticoagulation and for those with anticoagulation, respectively (p = 0.002). There was a strong association between CHADS2 and LA thrombus, and between CHADS2VASC and LA thrombus in the two groups. No thrombus was identified in patients with CHADS2VASC score of 0 in both groups. However, thrombus was detected in 3.5% of patients with CHADS2 score of 0 in the group without anticoagulation, while no thrombus was present in the ones with anticoagulation. CHADS2VASC score of ≥1 (r=2.03, p = 0.04) was the only factor independently associated with LA thrombus in patients without anticoagulation, while both CHADS2VASC score of ≥2 (r=2.61, p=0.02) and CHADS2 score of ≥2 (r=2.73, p=0.01) were independently associated with LA thrombus. Further analyses showed that CHADS2VASC score was a better predictor for LA thrombus than CHADS2 score in patients without anticoagulation. However, there was no difference between the two scoring systems in predicting LA thrombus in patients with anticoagulation. Conclusions: LA thrombus was associated with CHADS2VASC and CHADS2 scores in non-valvular AF patients without anticoagulation. CHADS2VASC score was a better predictor than CHADS2 score for LA thrombus in patients without anticoagulation. The data suggested that it might be unnecessary to undergo a TEE evaluation for LA thrombus in low risk patients identified by CHADS2VASC score regardless anticoagulation therapy prior to cardioversion or ablation.

Download Full-text