The Cardiac Arrhythmia Center at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R., L.D.B., K.P., M.P., I.A., J.C.D., R.Y.).
Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (L.D.B., S.M., C.T., V.N., J.S., D.G.D.R., P.M., C.G., R.H., D.B., A.A.-A., A.N.).
Circ Arrhythm Electrophysiol. 2020 Nov;13(11):e008390. doi: 10.1161/CIRCEP.120.008390. Epub 2020 Sep 30.
Left atrial appendage electrical isolation (LAAEI) has been proposed for the treatment of nonparoxysmal atrial fibrillation (AF). The long-term clinical outcomes of this approach remain unclear. The objective of our study was to investigate the incremental benefit and safety of LAAEI in patients undergoing catheter ablation for nonparoxysmal AF.
Propensity score-matched analysis was performed using a prospective registry database from 2010 to 2014. All patients in the LAAEI group were matched based on baseline characteristics, echocardiographic parameters, and procedural ablation techniques.
We identified 1842 patients who underwent catheter ablation for nonparoxysmal AF. Propensity score matching yielded 1092 patients, 546 patients with LAAEI, and 546 patients without LAAEI. At 5-year follow-up, overall freedom from all-atrial arrhythmia recurrence, off-antiarrhythmic drugs, in patients who underwent LAAEI was 68.9% versus 50.2% in those who underwent standard ablation alone (<0.001). Acute complication rates were similar between groups (LAAEI 1.3% versus non-LAAEI 0.73%, =0.36). At 5-year follow-up, 382 (70%) patients in the LAAEI group remained on oral anticoagulation versus 217 (39.7%) in the non-LAAEI group. At 5-year follow-up, thromboembolic events occurred in 15/546 (2.75%) in the LAAEI group and 4/546 (0.73%) in the non-LAAEI group (=0.01). No thromboembolic events occurred in either group on-oral anticoagulation. In patients who were off-oral anticoagulation, at 5-year follow-up, thromboembolic events occurred in 15/164 (9.1%) in the LAAEI group and 4/329 (1.2%) in the non-LAAEI group (<0.001).
At 5-year follow-up, LAAEI was associated with significantly higher freedom from all-atrial arrhythmia recurrence in patients with persistent and long-standing persistent AF without increasing acute procedural complication rate. In patients off-oral anticoagulation, there appears to be a higher risk of thromboembolic events in the LAAEI group.
左心耳电隔离（LAAEI）已被提议用于治疗非阵发性心房颤动（AF）。这种方法的长期临床结果尚不清楚。我们的研究目的是探讨 LAAEI 在接受导管消融治疗非阵发性 AF 患者中的额外获益和安全性。
使用 2010 年至 2014 年的前瞻性注册数据库进行倾向评分匹配分析。LAAEI 组的所有患者均根据基线特征、超声心动图参数和程序消融技术进行匹配。
我们确定了 1842 例接受非阵发性 AF 导管消融的患者。倾向评分匹配后，共有 1092 例患者，其中 546 例接受 LAAEI，546 例未接受 LAAEI。在 5 年随访时，LAAEI 组患者总体无所有心房心律失常复发、无抗心律失常药物的比例为 68.9%，而仅接受标准消融的患者为 50.2%（<0.001）。两组急性并发症发生率相似（LAAEI 组 1.3%，非 LAAEI 组 0.73%，=0.36）。在 5 年随访时，LAAEI 组 382 例（70%）患者继续接受口服抗凝治疗，而非 LAAEI 组 217 例（39.7%）。在 5 年随访时，LAAEI 组发生血栓栓塞事件 15/546（2.75%）例，非 LAAEI 组发生 4/546（0.73%）例（=0.01）。两组均未发生抗凝治疗期间的血栓栓塞事件。在未接受口服抗凝治疗的患者中，在 5 年随访时，LAAEI 组发生血栓栓塞事件 15/164（9.1%）例，而非 LAAEI 组发生 4/329（1.2%）例（<0.001）。
在 5 年随访时，LAAEI 与持续性和长期持续性 AF 患者中所有心房心律失常复发的无复发率显著提高相关，而不会增加急性手术并发症的发生率。在未接受口服抗凝治疗的患者中，LAAEI 组似乎有更高的血栓栓塞事件风险。
