Objective: Catheter ablation combined with left atrial appendage closure (LAAC) has emerged as a promising strategy for atrial fibrillation (AF) patients at high risk for stroke or with contraindications for oral anticoagulants (OACs). But the evidence for the long-term safety and efficacy of a combined procedure using cryoballoon ablation (CBA) with LAAC is still insufficient. Methods: From October 2015 to December 2017, a total of 76 consecutive non-valvular, drug-refractory AF patients who underwent a combined procedure of CBA and LAAC are included. Peri- and post-procedural safety and efficacy were evaluated through scheduled follow-ups and transesophageal echocardiography (TEE). Results: A total of 74 patients (97.4%) underwent the combined procedure and achieved instant pulmonary vein isolation and satisfactory LAAC. With a mean follow-up time of 23.7 ± 11.0 months, the recurrence of atrial arrhythmia was recorded in 35 patients (48.0%). In addition, a survival analysis shows a non-significant higher recurrence in persistent AF (p = 0.48). The overall OAC withdrawal rate was 97.2%, and one patient (1.4%) had a lethal hemorrhagic stroke while on single antiplatelet therapy. For safety concerns, the overall mortality was 2.7%, which resulted from one case of myocardial infarction on OAC and one hemorrhagic stroke, as mentioned. No other major hemorrhagic events occurred. Among the 72 patients (94.7%) who underwent TEE, one patient (1.4%) had device-related thrombosis and one patient (1.4%) had prominent residual flow (over 3 mm). Both were prescribed long-term OACs without severe complications occurring. Conclusions: Combining CBA with LAAC in a single procedure achieved considerable long-term safety and efficacy, providing a promising strategy for AF management.
Objective: Catheter ablation combined with left atrial appendage closure (LAAC) has emerged as a promising strategy for atrial fibrillation (AF) patients at high risk for stroke or with contraindications for oral anticoagulants (OACs). But the evidence for the long-term safety and efficacy of a combined procedure using cryoballoon ablation (CBA) with LAAC is still insufficient. Methods: From October 2015 to December 2017, a total of 76 consecutive non-valvular, drug-refractory AFpatients who underwent a combined procedure of CBA and LAAC are included. Peri- and post-procedural safety and efficacy were evaluated through scheduled follow-ups and transesophageal echocardiography (TEE). Results: A total of 74 patients (97.4%) underwent the combined procedure and achieved instant pulmonary vein isolation and satisfactory LAAC. With a mean follow-up time of 23.7 ± 11.0 months, the recurrence of atrial arrhythmia was recorded in 35 patients (48.0%). In addition, a survival analysis shows a non-significant higher recurrence in persistent AF (p = 0.48). The overall OAC withdrawal rate was 97.2%, and one patient (1.4%) had a lethal hemorrhagic stroke while on single antiplatelet therapy. For safety concerns, the overall mortality was 2.7%, which resulted from one case of myocardial infarction on OAC and one hemorrhagic stroke, as mentioned. No other major hemorrhagic events occurred. Among the 72 patients (94.7%) who underwent TEE, one patient (1.4%) had device-related thrombosis and one patient (1.4%) had prominent residual flow (over 3 mm). Both were prescribed long-term OACs without severe complications occurring. Conclusions: Combining CBA with LAAC in a single procedure achieved considerable long-term safety and efficacy, providing a promising strategy for AF management.
Authors: Arash Aryana; James H Baker; Martin A Espinosa Ginic; Deep K Pujara; Mark R Bowers; P Gearoid O'Neill; Kenneth A Ellenbogen; Luigi Di Biase; André d'Avila; Andrea Natale Journal: Heart Rhythm Date: 2018-08 Impact factor: 6.343
Authors: Michael Glikson; Rafael Wolff; Gerhard Hindricks; John Mandrola; A John Camm; Gregory Y H Lip; Laurent Fauchier; Tim R Betts; Thorsten Lewalter; Jacqueline Saw; Apostolos Tzikas; Leonid Sternik; Fabian Nietlispach; Sergio Berti; Horst Sievert; Stefan Bertog; Bernhard Meier Journal: EuroIntervention Date: 2020-01-17 Impact factor: 6.534
Authors: David R Holmes; Saibal Kar; Matthew J Price; Brian Whisenant; Horst Sievert; Shephal K Doshi; Kenneth Huber; Vivek Y Reddy Journal: J Am Coll Cardiol Date: 2014-07-08 Impact factor: 24.094
Authors: Karen P Phillips; Evgeny Pokushalov; Aleksandr Romanov; Sergey Artemenko; Richard J Folkeringa; Tamas Szili-Torok; Gaetano Senatore; Kenneth M Stein; Omar Razali; Nicole Gordon; Lucas V A Boersma Journal: Europace Date: 2018-06-01 Impact factor: 5.214