Kewcharoen Jakrin, Shah Kuldeep, Bhardwaj Rahul, Contractor Tahmeed, Ramsingh Davendra, Turagam Mohit K, Mandapati Ravi, Lakkireddy Dhanunjaya, Garg Jalaj
Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA.
Division of Cardiology, Cardiac Arrhythmia Service, MercyOne Siouxland Heart and Vascular Center, Sioux City, IA, USA.
J Interv Card Electrophysiol. 2024 Sep 11. doi: 10.1007/s10840-024-01914-8.
The safety and efficacy of CA for AF and left-sided atrial arrhythmias (AA) in patients with left atrial appendage occlusion (LAAO) devices are lacking.
This is a single-center retrospective registry that included all patients with prior LAAO who underwent catheter ablation for AF or left-sided atrial arrhythmia from January 2020-January 2023. The primary outcomes were procedure-related complications, device-related complications, AA recurrence, and stroke.
A total of 30 patients with prior LAAO were included in the analysis (mean age 75.1 ± 7.1 years old, 50% male, mean CHADS-VASc score 4 ± 1.6, 46.7% paroxysmal AF, 73.3% had prior AF ablation, mean time to ablation 475 ± 365 days). 93.3% (n = 28) and 6.6% (n = 2) patients had ablation for AF (46.7% paroxysmal, 36.7% persistent, 10% long-standing persistent) and left-sided atrial tachycardia, respectively. 16.7% (n = 5) patients underwent ablation along the left atrial appendage ostium, and 3.3% (n = 1) underwent Vein of Marshall alcohol ablation. There were 3 (10%) peri-procedural complications (1 access hematoma and two pericardial effusions requiring intervention-none related to left atrial appendage ostium or alcohol ablation). During the mean follow-up of 440 ± 379 days, 40% (n = 12) patients had AA recurrence (91.6% AF, 8.3% atrial tachycardia), of which five patients needed repeat ablation, and two patients were readmitted for heart failure. There was no stroke or any device-related complications, including new peri-device leaks or device-related thrombosis in patients who had follow-up imaging studies (n = 11, 36.7%).
Catheter ablation for AF (including VoM alcohol ablation) in patients with prior LAAO devices is feasible and safe with favorable outcomes.
左心耳封堵（LAAO）装置植入患者中，导管消融（CA）治疗房颤（AF）和左侧房性心律失常（AA）的安全性和有效性尚缺乏研究。
这是一项单中心回顾性注册研究，纳入了2020年1月至2023年1月期间所有既往接受过LAAO且因AF或左侧房性心律失常接受导管消融治疗的患者。主要结局为手术相关并发症、装置相关并发症、AA复发和卒中。
共30例既往有LAAO的患者纳入分析（平均年龄75.1±7.1岁，50%为男性，平均CHADS-VASc评分4±1.6，46.7%为阵发性AF，73.3%既往有AF消融史，平均消融时间475±365天）。分别有93.3%（n = 28）和6.6%（n = 2）的患者接受AF消融（46.7%为阵发性，36.7%为持续性，10%为长期持续性）和左侧房性心动过速消融。16.7%（n = 5）的患者沿左心耳开口进行消融，3.3%（n = 1）的患者接受Marshall静脉酒精消融。围手术期有3例（10%）并发症（1例穿刺部位血肿和2例心包积液需干预，均与左心耳开口或酒精消融无关）。在平均440±379天的随访期间，40%（n = 12）的患者出现AA复发（91.6%为AF，8.3%为房性心动过速），其中5例患者需要再次消融，2例患者因心力衰竭再次入院。在接受随访影像学检查的患者（n = 11，36.7%）中，未发生卒中或任何装置相关并发症，包括新的装置周围渗漏或装置相关血栓形成。
既往有LAAO装置的患者进行AF导管消融（包括Marshall静脉酒精消融）是可行且安全的，预后良好。
