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JACC Clin Electrophysiol. 2015 Jun;1(3):153-160. doi: 10.1016/j.jacep.2015.04.006. Epub 2015 Apr 30.

Left Atrial Appendage Ligation and Ablation for Persistent Atrial Fibrillation: The LAALA-AF Registry.

Author information

1
Section of Cardiology, University of Kansas Hospital and Medical Center, Kansas City, Kansas. Electronic address: dlakkireddy@kumc.edu.
2
Section of Cardiology, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
3
Section of Cardiology, University of California at San Francisco, San Francisco, California.
4
Section of Cardiology, Jagiellonian University, John Paul II Hospital, Krakow, Poland.
5
Section of Cardiology, Texas Heart Institute, Houston, Texas.
6
Section of Cardiology, Texas Cardiac Arrhythmia Institute, Austin, Texas.

Abstract

OBJECTIVES:

This study was intended to evaluate the impact of adding the left atrial appendage (LAA) closure system (LARIAT) procedure to conventional atrial fibrillation (AF) ablation in patients with persistent AF.

BACKGROUND:

Percutaneous endoepicardial LARIAT may result in both mechanical and electrical exclusion of the LAA and aid in improving the outcomes of catheter ablation by eradicating the LAA triggers and altering the substrate.

METHODS:

We performed a prospective observational study of patients with persistent AF referred for AF ablation. Patients underwent LAA ligation with LARIAT procedure before undergoing AF ablation (LARIAT group). Age- and sex-matched persistent AF patients undergoing AF ablation during the same time frame were included in the control group (ablation-only group).

RESULTS:

A total of 138 patients were included in the study, with 69 patients in the LARIAT group. The mean age of the population was 67 ± 10 years, with 96 (70%) men. Left atrial (LA) size, CHADS2, CHADSVasc, and HAS-BLED scores were higher in the LARIAT group when compared with the ablation-only group. There were no differences in the type of lesions during AF ablation between the groups. The primary outcome of freedom from AF at 1 year off antiarrhythmic therapy after 1 ablation procedure was higher in the LARIAT group (45 [65%] vs. 27 [39%]; p = 0.002). More patients in the ablation-only group underwent repeat ablation because of AF recurrence (11 [16%] vs. 23 [33%]; p = 0.018).

CONCLUSIONS:

In patients with persistent AF, addition of LAA ligation with the LARIAT device to conventional ablation appears to improve the success rate of AF ablation.

KEYWORDS:

atrium; catheter ablation; fibrillation; stroke

PMID:
29759358
DOI:
10.1016/j.jacep.2015.04.006
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