Abstract 15059: Prevalence of Recovery of Conduction in the Left Atrial Appendage Following Electrical Isolation of the Appendage in Patients With Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sanghamitra Mohanty ◽  
CHINTAN G TRIVEDI ◽  
Domenico G Della Rocca ◽  
Carola Gianni ◽  
Faiz M Baqai ◽  
...  
Keyword(s):  
Success Rate ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Transesophageal Echocardiogram ◽  
Reconnection Rate ◽  
Electrical Isolation ◽  
Repeat Procedure ◽  
Isoproterenol Infusion ◽  
Af Recurrence

Background: Electrical isolation of the left atrial appendage (LAAEI) is considered in patients presenting with recurrence following effective PV isolation. Objective: We evaluated the prevalence of LAA reconnection following LAAEI in patients undergoing repeat procedure for AF recurrence. Methods: Consecutive AF patients undergoing repeat ablation for arrhythmia recurrence following LAAEI were included in this analysis. Transesophageal echocardiogram (TEE) was performed in all at baseline to evaluate LAA function. Isoproterenol infusion up to 30 μg/min for 10 to 15 min was administered to detect LAA triggers. Re-isolation of the LAA was performed if triggers were detected. Off-drug success rate was assessed in all. Results: A total of 594 post-LAAEI patients with recurrent AF were included in the analysis. At the redo, PVs were found to be electrically silent in all. LAA reconnection was detected in 214 (36%) patients. Baseline TEE revealed normal LAA contractility and flow-velocity in all. Re-isolation of the LAA was performed in these 214 patients. In patients with no LAA reconnection (n=380), non-PV triggers from other sites were targeted for ablation. There was no difference in the clinical characteristics of patients with vs. without LAA reconnection (Table). At 2 years after the repeat procedure, 201 (94%) patients with and 351 (92.3%) without LAA reconnection were arrhythmia-free off-drugs (p=0.47). Conclusion: In this series, LAA reconnection rate was 36% after single LAAEI procedure and re-isolation of the appendage led to high success rate. Additionally, normal LAA functions detected by TEE correctly predicted recovery of conduction in the LAA.

Left atrial appendage electrical isolation for persistent atrial fibrillation

2018 ◽  
Vol 42 (3) ◽  
pp. 306-308
Author(s):  
Antonio Madaffari ◽  
Anett Große ◽  
Elisabetta Conci ◽  
J. Christoph Geller
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Persistent Atrial Fibrillation ◽  
Atrial Appendage ◽  
Electrical Isolation

The left atrial appendage in humans: structure, physiology, and pathogenesis

EP Europace ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 5-18 ◽  
Author(s):  
Nabeela Karim ◽  
Siew Yen Ho ◽  
Edward Nicol ◽  
Wei Li ◽  
Filip Zemrak ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Therapeutic Target ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Electrical Isolation ◽  
Haemodynamic Changes ◽  
Peptide Secretion

Abstract For many years, the left atrial appendage (LAA) was considered a dormant embryological remnant; however, it is a structurally complex and functional organ that contributes to cardiac haemodynamic changes and volume homeostasis through both its contractile properties and neurohormonal peptide secretion. When dysfunctional, the LAA contributes to thrombogenesis and subsequent increased predisposition to cardioembolic events. Consequently, the LAA has gained much attention as a therapeutic target to lower this risk. In addition, attention has focused on the LAA in its role as an electrical trigger for atrial tachycardia and atrial fibrillation with ablation of the LAA to achieve electrical isolation showing promising results in the maintenance of sinus rhythm. This in-depth review explores the structure, physiology and pathophysiology of the LAA, as well as LAA intervention and their sequelae.

scholarly journals Left atrial appendage (LAA) electrical isolation by Maze‐like catheter substrate modification in presence of LAA‐occluder device: A case report

2020 ◽  
Vol 8 (10) ◽  
pp. 2021-2024
Author(s):  
Simone Zanchi ◽  
Lorenzo Bianchini ◽  
Stefano Bordignon ◽  
Fabrizio Bologna ◽  
Shota Tohoku ◽  
...  
Keyword(s):  
Case Report ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Electrical Isolation ◽  
Substrate Modification ◽  
Occluder Device

scholarly journals Left Atrial Appendage Electrical Isolation as a Target in Atrial Fibrillation

2019 ◽  
Vol 5 (4) ◽  
pp. 407-416 ◽  
Author(s):  
Marin Nishimura ◽  
Florentino Lupercio-Lopez ◽  
Jonathan C. Hsu
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Electrical Isolation

A Stunning Left Atrial Appendage Thrombus

Cardiology ◽  
2016 ◽  
Vol 134 (4) ◽  
pp. 394-397
Author(s):  
Sajid Ali ◽  
Justin Ugwu ◽  
Yousuf Kanjwal
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Atrial Flutter ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Atrial Appendage ◽  
Transesophageal Echocardiogram ◽  
Left Atrial Appendage Thrombus

Background: Left atrial appendage thrombus formation is a known major complication of atrial fibrillation and atrial flutter which increases the risk of embolism and stroke. This risk of thrombosis is greatly increased with a lack of anticoagulation. After conversion to a normal sinus rhythm in these arrhythmias, the risk of thrombus formation in the left atrium persists through a phenomenon termed atrial myocardial stunning. Case: We present the case of a patient who previously underwent successful pulmonary vein isolation and was found to be in typical isthmus-dependent atrial flutter with a questionable recurrence of atrial fibrillation. The decision was made to return for atrial flutter ablation and for evaluation of prior pulmonary vein isolation. Initially, a transesophageal echocardiogram showed a normal ejection fraction, biatrial enlargement and no left atrial appendage thrombus. Ablation of the cavotricuspid isthmus was successfully accomplished with documented bidirectional block. A transesophageal echocardiogram probe was still in place prior to planned transseptal puncture for the evaluation of pulmonary veins. A large thrombus was now observed filling the left atrial appendage. Conclusion and Objective: Atrial stunning is a transient atrial contractile dysfunction that occurs whether sinus rhythm is restored spontaneously, electrically, pharmacologically or by ablation. We know after conversion that there is higher propensity to increased spontaneous echogenic contrast and decreased velocities; however, we do not have documented knowledge of exactly how soon after the conversion to a sinus rhythm a thrombus may be seen. We demonstrate a case of acute left atrial appendage thrombus formation immediately following the successful ablation of isthmus-dependent atrial flutter. Our report validates the belief that strategies of not interrupting anticoagulation prior to the conversion of these arrhythmias should be implemented.

Effect of low-dose isoproterenol infusion on left atrial appendage function soon after cardioversion of chronic atrial tachyarrhythmias

2002 ◽  
Vol 84 (1) ◽  
pp. 59-67 ◽  
Author(s):  
Taro Date ◽  
Atsushi Takahashi ◽  
Yoshito Iesaka ◽  
Hidekazu Miyazaki ◽  
Teiichi Yamane ◽  
...  
Keyword(s):  
Left Atrial ◽  
Low Dose ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Atrial Tachyarrhythmias ◽  
Isoproterenol Infusion
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