Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation
Introduction It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients. Methods Consecutive patients undergoing catheter ablation for AF...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2019-03, Vol.30 (3), p.339-347 |
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| creator | Mohanty, Sanghamitra Di Biase, Luigi Trivedi, Chintan Choudhury, Fahim Della Rocca, Domenico G. Romero, Jorge Gianni, Carola Sanchez, Javier Hranitzky, Patrick Gallinghouse, G. Joseph Al‐Ahmad, Amin Horton, Rodney P. Burkhardt, David Natale, Andrea |
| description | Introduction
It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients.
Methods
Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non‐PV) triggers were ablated based on operator's discretion.
Results
A total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non‐PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow‐up, 126 (86.9%) patients from group I, eight (19.5%) from group II, and eight (33.3%) from group III remained arrhythmia‐free off antiarrhythmic drugs (AAD) (P |
| doi_str_mv | 10.1111/jce.13825 |
| format | Article |
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It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients.
Methods
Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non‐PV) triggers were ablated based on operator's discretion.
Results
A total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non‐PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow‐up, 126 (86.9%) patients from group I, eight (19.5%) from group II, and eight (33.3%) from group III remained arrhythmia‐free off antiarrhythmic drugs (AAD) (P < 0.001). Sixty out of 70 patients underwent redo procedure; electrical isolation of the stump and ablation of other non‐PV triggers was done in all 60 cases. At 1 year after the repeat procedure, 55 (91.7%) patients remained arrhythmia‐free off‐AAD. A total of four (1.88%) thromboembolic (TE) events reported, three of which were transient ischemic attacks and all three patients had “smoke” detected in the left atrium.
Conclusion
LAA stump is arrhythmogenic and electrical isolation improves clinical outcome. TE events are rare and mostly associated with left atrial smoke in this subset of AF population.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.13825</identifier><identifier>PMID: 30575181</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Ablation ; Aged ; Amputation ; Arrhythmia ; Atrial Appendage - diagnostic imaging ; Atrial Appendage - physiopathology ; Atrial Appendage - surgery ; Atrial Fibrillation - complications ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Atrium ; Cardiac arrhythmia ; Cardiac Surgical Procedures - adverse effects ; Catheters ; Echocardiography ; Electrocardiography ; Female ; Fibrillation ; Humans ; Ischemia ; Ischemic Attack, Transient - diagnostic imaging ; Ischemic Attack, Transient - etiology ; left atrial appendage ; Male ; Medical instruments ; Middle Aged ; nonpulmonary vein triggers ; Progression-Free Survival ; Recurrence ; Registries ; Risk Assessment ; Risk Factors ; Smoke ; stroke ; stump ; Thromboembolism ; Thromboembolism - diagnostic imaging ; Thromboembolism - etiology ; Time Factors ; transient ischemic attack</subject><ispartof>Journal of cardiovascular electrophysiology, 2019-03, Vol.30 (3), p.339-347</ispartof><rights>2018 Wiley Periodicals, Inc.</rights><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3535-451f155b0fde344d1d12aacd9ca11d47ffc3a7ed8aa6ca59b21ad8d6c8f058963</citedby><cites>FETCH-LOGICAL-c3535-451f155b0fde344d1d12aacd9ca11d47ffc3a7ed8aa6ca59b21ad8d6c8f058963</cites><orcidid>0000-0002-5487-0728 ; 0000-0003-3837-3462 ; 0000-0001-6601-944X ; 0000-0001-6508-4047</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.13825$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.13825$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30575181$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mohanty, Sanghamitra</creatorcontrib><creatorcontrib>Di Biase, Luigi</creatorcontrib><creatorcontrib>Trivedi, Chintan</creatorcontrib><creatorcontrib>Choudhury, Fahim</creatorcontrib><creatorcontrib>Della Rocca, Domenico G.</creatorcontrib><creatorcontrib>Romero, Jorge</creatorcontrib><creatorcontrib>Gianni, Carola</creatorcontrib><creatorcontrib>Sanchez, Javier</creatorcontrib><creatorcontrib>Hranitzky, Patrick</creatorcontrib><creatorcontrib>Gallinghouse, G. Joseph</creatorcontrib><creatorcontrib>Al‐Ahmad, Amin</creatorcontrib><creatorcontrib>Horton, Rodney P.</creatorcontrib><creatorcontrib>Burkhardt, David</creatorcontrib><creatorcontrib>Natale, Andrea</creatorcontrib><title>Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction
It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients.
Methods
Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non‐PV) triggers were ablated based on operator's discretion.
Results
A total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non‐PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow‐up, 126 (86.9%) patients from group I, eight (19.5%) from group II, and eight (33.3%) from group III remained arrhythmia‐free off antiarrhythmic drugs (AAD) (P < 0.001). Sixty out of 70 patients underwent redo procedure; electrical isolation of the stump and ablation of other non‐PV triggers was done in all 60 cases. At 1 year after the repeat procedure, 55 (91.7%) patients remained arrhythmia‐free off‐AAD. A total of four (1.88%) thromboembolic (TE) events reported, three of which were transient ischemic attacks and all three patients had “smoke” detected in the left atrium.
Conclusion
LAA stump is arrhythmogenic and electrical isolation improves clinical outcome. TE events are rare and mostly associated with left atrial smoke in this subset of AF population.</description><subject>Ablation</subject><subject>Aged</subject><subject>Amputation</subject><subject>Arrhythmia</subject><subject>Atrial Appendage - diagnostic imaging</subject><subject>Atrial Appendage - physiopathology</subject><subject>Atrial Appendage - surgery</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Atrium</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac Surgical Procedures - adverse effects</subject><subject>Catheters</subject><subject>Echocardiography</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Ischemic Attack, Transient - diagnostic imaging</subject><subject>Ischemic Attack, Transient - etiology</subject><subject>left atrial appendage</subject><subject>Male</subject><subject>Medical instruments</subject><subject>Middle Aged</subject><subject>nonpulmonary vein triggers</subject><subject>Progression-Free Survival</subject><subject>Recurrence</subject><subject>Registries</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Smoke</subject><subject>stroke</subject><subject>stump</subject><subject>Thromboembolism</subject><subject>Thromboembolism - diagnostic imaging</subject><subject>Thromboembolism - etiology</subject><subject>Time Factors</subject><subject>transient ischemic attack</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctq3DAUhk1paC7toi9QBN00Cyc6luXLMgzpjUA2ydrI0tGMBllyJZnpvE8ftEom00Kh2ujw69PHgb8o3gO9gnyutxKvgHUVf1WcAa9p2UHTvs4zrXnJupadFucxbikF1lD-pjhllLccOjgrft2EsNmnzeTX6FCatCfCKZI2wU_jU2aeM69zhCRgNGoRlljUiYgUTJ7FPKNTYo0kpmWaifbW-p1xaxKXsDYyI_hT2iUa746iv3-MI7NIBl2KZGfS5mjVZgzG2vzk3dviRAsb8d3LfVE8fr59WH0t7-6_fFvd3JWSccbLmoMGzkeqFbK6VqCgEkKqXgoAVbdaSyZaVJ0QjRS8HysQqlON7DTlXd-wi-LTwTsH_2PBmIbJRIl5C4d-iUMFvO87Bg3L6Md_0K1fgsvbZapnFTS0qTJ1eaBk8DEG1MMczCTCfgA6PFU35OqG5-oy--HFuIwTqj_ksasMXB-AnbG4_79p-L66PSh_A5j8p4M</recordid><startdate>201903</startdate><enddate>201903</enddate><creator>Mohanty, Sanghamitra</creator><creator>Di Biase, Luigi</creator><creator>Trivedi, Chintan</creator><creator>Choudhury, Fahim</creator><creator>Della Rocca, Domenico G.</creator><creator>Romero, Jorge</creator><creator>Gianni, Carola</creator><creator>Sanchez, Javier</creator><creator>Hranitzky, Patrick</creator><creator>Gallinghouse, G. Joseph</creator><creator>Al‐Ahmad, Amin</creator><creator>Horton, Rodney P.</creator><creator>Burkhardt, David</creator><creator>Natale, Andrea</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5487-0728</orcidid><orcidid>https://orcid.org/0000-0003-3837-3462</orcidid><orcidid>https://orcid.org/0000-0001-6601-944X</orcidid><orcidid>https://orcid.org/0000-0001-6508-4047</orcidid></search><sort><creationdate>201903</creationdate><title>Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation</title><author>Mohanty, Sanghamitra ; Di Biase, Luigi ; Trivedi, Chintan ; Choudhury, Fahim ; Della Rocca, Domenico G. ; Romero, Jorge ; Gianni, Carola ; Sanchez, Javier ; Hranitzky, Patrick ; Gallinghouse, G. Joseph ; Al‐Ahmad, Amin ; Horton, Rodney P. ; Burkhardt, David ; Natale, Andrea</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3535-451f155b0fde344d1d12aacd9ca11d47ffc3a7ed8aa6ca59b21ad8d6c8f058963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Ablation</topic><topic>Aged</topic><topic>Amputation</topic><topic>Arrhythmia</topic><topic>Atrial Appendage - diagnostic imaging</topic><topic>Atrial Appendage - physiopathology</topic><topic>Atrial Appendage - surgery</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Atrium</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac Surgical Procedures - adverse effects</topic><topic>Catheters</topic><topic>Echocardiography</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Ischemic Attack, Transient - diagnostic imaging</topic><topic>Ischemic Attack, Transient - etiology</topic><topic>left atrial appendage</topic><topic>Male</topic><topic>Medical instruments</topic><topic>Middle Aged</topic><topic>nonpulmonary vein triggers</topic><topic>Progression-Free Survival</topic><topic>Recurrence</topic><topic>Registries</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Smoke</topic><topic>stroke</topic><topic>stump</topic><topic>Thromboembolism</topic><topic>Thromboembolism - diagnostic imaging</topic><topic>Thromboembolism - etiology</topic><topic>Time Factors</topic><topic>transient ischemic attack</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mohanty, Sanghamitra</creatorcontrib><creatorcontrib>Di Biase, Luigi</creatorcontrib><creatorcontrib>Trivedi, Chintan</creatorcontrib><creatorcontrib>Choudhury, Fahim</creatorcontrib><creatorcontrib>Della Rocca, Domenico G.</creatorcontrib><creatorcontrib>Romero, Jorge</creatorcontrib><creatorcontrib>Gianni, Carola</creatorcontrib><creatorcontrib>Sanchez, Javier</creatorcontrib><creatorcontrib>Hranitzky, Patrick</creatorcontrib><creatorcontrib>Gallinghouse, G. Joseph</creatorcontrib><creatorcontrib>Al‐Ahmad, Amin</creatorcontrib><creatorcontrib>Horton, Rodney P.</creatorcontrib><creatorcontrib>Burkhardt, David</creatorcontrib><creatorcontrib>Natale, Andrea</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mohanty, Sanghamitra</au><au>Di Biase, Luigi</au><au>Trivedi, Chintan</au><au>Choudhury, Fahim</au><au>Della Rocca, Domenico G.</au><au>Romero, Jorge</au><au>Gianni, Carola</au><au>Sanchez, Javier</au><au>Hranitzky, Patrick</au><au>Gallinghouse, G. Joseph</au><au>Al‐Ahmad, Amin</au><au>Horton, Rodney P.</au><au>Burkhardt, David</au><au>Natale, Andrea</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2019-03</date><risdate>2019</risdate><volume>30</volume><issue>3</issue><spage>339</spage><epage>347</epage><pages>339-347</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Introduction
It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients.
Methods
Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non‐PV) triggers were ablated based on operator's discretion.
Results
A total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non‐PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow‐up, 126 (86.9%) patients from group I, eight (19.5%) from group II, and eight (33.3%) from group III remained arrhythmia‐free off antiarrhythmic drugs (AAD) (P < 0.001). Sixty out of 70 patients underwent redo procedure; electrical isolation of the stump and ablation of other non‐PV triggers was done in all 60 cases. At 1 year after the repeat procedure, 55 (91.7%) patients remained arrhythmia‐free off‐AAD. A total of four (1.88%) thromboembolic (TE) events reported, three of which were transient ischemic attacks and all three patients had “smoke” detected in the left atrium.
Conclusion
LAA stump is arrhythmogenic and electrical isolation improves clinical outcome. TE events are rare and mostly associated with left atrial smoke in this subset of AF population.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30575181</pmid><doi>10.1111/jce.13825</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-5487-0728</orcidid><orcidid>https://orcid.org/0000-0003-3837-3462</orcidid><orcidid>https://orcid.org/0000-0001-6601-944X</orcidid><orcidid>https://orcid.org/0000-0001-6508-4047</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Ablation Aged Amputation Arrhythmia Atrial Appendage - diagnostic imaging Atrial Appendage - physiopathology Atrial Appendage - surgery Atrial Fibrillation - complications Atrial Fibrillation - diagnosis Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Atrium Cardiac arrhythmia Cardiac Surgical Procedures - adverse effects Catheters Echocardiography Electrocardiography Female Fibrillation Humans Ischemia Ischemic Attack, Transient - diagnostic imaging Ischemic Attack, Transient - etiology left atrial appendage Male Medical instruments Middle Aged nonpulmonary vein triggers Progression-Free Survival Recurrence Registries Risk Assessment Risk Factors Smoke stroke stump Thromboembolism Thromboembolism - diagnostic imaging Thromboembolism - etiology Time Factors transient ischemic attack |
| title | Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation |
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