Author + information
- Received June 20, 2018
- Revision received June 4, 2019
- Accepted June 13, 2019
- Published online August 19, 2019.
- Luigi Di Biase, MD, PhDa,b,∗@luigidibiasemd,
- Sanghamitra Mohanty, MDa,∗,
- Chintan Trivedi, MD, MPHa,
- Jorge Romero, MDb,
- Veronica Natale, MASc,
- David Briceno, MDb,
- Varuna Gadiyaram, MDd,
- Linda Couts, RNd,
- Carola Gianni, MD, PhDa,
- Amin Al-Ahmad, MDa,
- John David Burkhardt, MDa,
- G. Joseph Gallinghouse, MDa,
- Rodney Horton, MDa,
- Patrick M. Hranitzky, MDa,
- Javier E. Sanchez, MDa and
- Andrea Natale, MDd,e,f,∗ (, )@andreanatalemd
- aTexas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas
- bAlbert Einstein College of Medicine at Montefiore Hospital, New York, New York
- cJohns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- dInterventional Electrophysiology, Scripps Clinic, San Diego, California
- eMetro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- fDivision of Cardiology, Stanford University, Stanford, California
- ↵∗Address for correspondence:
Dr. Andrea Natale, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Suite 720, 3000 North I-35, Austin, Texas 78705.
Background Loss of contractility leading to stasis of blood flow following left atrial appendage electrical isolation (LAAEI) could lead to thrombus formation.
Objectives This study evaluated the incidence of thromboembolic events (TE) in post-LAAEI cases “on” and “off” oral anticoagulation (OAC).
Methods A total of 1,854 consecutive post-LAAEI patients with follow-up transesophageal echocardiography (TEE) performed in sinus rhythm at 6 months to assess left atrial appendage (LAA) function were included in this analysis.
Results The TEE at 6 months revealed preserved LAA velocity, contractility, and consistent A waves in 336 (18%) and abnormal parameters in the remaining 1,518 patients. In the post-ablation period, all 336 patients with preserved LAA function were off OAC. At long-term follow-up, patients with normal LAA function did not experience any stroke events. Of the 1,518 patients with abnormal LAA contractility, 1,086 remained on OAC, and the incidence of stroke/transient ischemic attack (TIA) in this population was 18 of 1,086 (1.7%), whereas the number of TE events in the off-OAC patients (n = 432) was 72 (16.7%); p < 0.001. Of the 90 patients with stroke, 84 received left atrial appendage occlusion (LAAO) devices. At median 12.4 months (interquartile range: 9.8 to 15.3 months) of device implantation, 2 (2.4%) patients were on OAC because of high stroke risk or personal preference, whereas 81 patients discontinued OAC after LAAO device implantation without any TE events.
Conclusions LAAEI is associated with a significant risk of stroke that can be effectively reduced by optimal uninterrupted OAC or LAAO devices.
- atrial fibrillation
- catheter ablation
- LAA function
- left atrial appendage electrical isolation
- left atrial appendage occlusion
- oral anticoagulant
- thromboembolic events
↵∗ Drs. Di Biase and Mohanty contributed equally to this work and are joint first authors.
Dr. Di Biase has served as a consultant for Biosense Webster, Boston Scientific, Stereotaxis, and St. Jude Medical; and has received speaker honoraria/travel support from Biosense Webster, St. Jude Medical, Boston Scientific, Medtronic, Bristol-Myers Squibb, Pfizer, and Biotronik. Dr. A. Natale has served as a consultant for Baylis Medical, Boston Scientific, Biosense Webster, Bristol-Myers Squibb, St. Jude Medical, Biotronik, and Medtronic. Dr. Burkhardt has served as a consultant/speaker for Biosense-Webster and Stereotaxis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received June 20, 2018.
- Revision received June 4, 2019.
- Accepted June 13, 2019.
- 2019 American College of Cardiology Foundation
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