Muhammad R Afzal1, Arun Kanmanthareddy1, Matthew Earnest1, Madhu Reddy1, Donita Atkins1, Sudharani Bommana1, Krystof Bartus2, Abdi Rasekh3, Fred Han4, Nitish Badhwar5, Jie Cheng6, Luigi Dibiase7, Christopher R Ellis8, Buddhadeb Dawn1, Andrea Natale7, Randall J Lee5, Dhanunjaya Lakkireddy9. 1. Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, Kansas. 2. John Paul II, Krakow, Poland. 3. Texas Heart Institute, St. Lukes Hospital, Houston, Texas. 4. University of Utah, Salt Lake City, Utah. 5. University of San Francisco, San Francisco, California. 6. Texas Heart Institute, St. Lukes Hospital, Houston, Texas; University of Texas, Houston, Texas. 7. Texas Cardiac Arrhythmia Institute, Austin, Texas. 8. Vanderbilt University Medical Center, Nashville, Tennessee. 9. Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, Kansas. Electronic address: dlakkireddy@mac.md.
Abstract
BACKGROUND: The left atrial appendage (LAA) is a well-known source of atrial arrhythmia and atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to determine whether LAA exclusion using the LARIAT device would decrease AF burden. METHODS: A total of 50 patients with AF and cardiac implantable electronic devices who underwent successful LAA exclusion were enrolled in this prospective observational study. AF burden before LAA exclusion (baseline) and 3 and 12 months after exclusion was assessed by device interrogation. RESULTS: AF burden at 3-month follow-up (42% ± 34%) was significantly lower compared to baseline (76% ± 33%, P < .0001). The reduction in AF burden was sustained at 12 months (59% ± 26%, P < .001). Subgroup analysis revealed that AF burden at 3-month follow-up was similarly reduced in both paroxysmal AF (n = 19) and nonparoxysmal AF (n = 31). However, there was no reduction in AF burden in patients with paroxysmal AF at 12 months. AF burden in patients with known AF triggers in the LAA (n = 9) was significantly reduced at 3 months (52% ± 35%) and 12 months (42% ± 19%) compared to respective baseline (84 ± 31%, P < .0001). CONCLUSION: LAA exclusion appears to reduce AF burden. The presence of AF triggers in the LAA appears to be the strongest predictor of AF reduction. The study underscores the role of the LAA in arrhythmogenesis for AF and highlights the complementary role of LAA exclusion in restoration of normal sinus rhythm.
BACKGROUND: The left atrial appendage (LAA) is a well-known source of atrial arrhythmia and atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to determine whether LAA exclusion using the LARIAT device would decrease AF burden. METHODS: A total of 50 patients with AF and cardiac implantable electronic devices who underwent successful LAA exclusion were enrolled in this prospective observational study. AF burden before LAA exclusion (baseline) and 3 and 12 months after exclusion was assessed by device interrogation. RESULTS:AF burden at 3-month follow-up (42% ± 34%) was significantly lower compared to baseline (76% ± 33%, P < .0001). The reduction in AF burden was sustained at 12 months (59% ± 26%, P < .001). Subgroup analysis revealed that AF burden at 3-month follow-up was similarly reduced in both paroxysmal AF (n = 19) and nonparoxysmal AF (n = 31). However, there was no reduction in AF burden in patients with paroxysmal AF at 12 months. AF burden in patients with known AF triggers in the LAA (n = 9) was significantly reduced at 3 months (52% ± 35%) and 12 months (42% ± 19%) compared to respective baseline (84 ± 31%, P < .0001). CONCLUSION:LAA exclusion appears to reduce AF burden. The presence of AF triggers in the LAA appears to be the strongest predictor of AF reduction. The study underscores the role of the LAA in arrhythmogenesis for AF and highlights the complementary role of LAA exclusion in restoration of normal sinus rhythm.