Left Atrial Appendage Closure: Killing 2 Birds With 1 Stone? | Journal of the American Heart Association

This report link was shared by one of our members.

I'm sure Shannon will have comments.

Jackie


[jaha.ahajournals.org]

[doi.org]
Journal of the American Heart Association. 2015;4:002028
Originally published May 14, 2015

Hi Jackie,

This is a pretty good overall review of the LAA Closure issue. Dr Vivek Reddy's "In Defense of LAA Closure" editorial in Medscape a little over a month ago is also excellent!

Regarding whether or not it is a good idea to perform, both a basic AFIB PVI ablation and install an LAA Closure system as part of the same procedure? While a couple of groups have done so as a proof that it can be done, it is not widely recommended to do both at the same time.

At the recent big annual AF Symposium 2017 I attended last week in Orlando, 'LAA isolation', 'LAA Closure' and the importance of including 'Non-PV trigger detection and ablation' as key steps in a more comprehensive AFIB ablation protocol, were ... like last year all three major hot topics of interest for discussion ... several excellent reviews of recent LAA Closure studies.

One of them discussed the pros and cons of trying to do both PVI ablation and LAA Closure at the same time. Either via an endocardial occlusion like the Watchman or Amplatzer Amulet device, or with an epicardial phase added to an LAA closure via the LARIAT-PLUS or Atriclip procedures.

In either case, there is a clear preference for doing AFIB ablation and LAA Closure as two separate procedures, even though technically at least can be feasible to do both at the same time.

In this one study they showed a clear reason why using a Watchman or Amulet method at the same time you do the PVI ablation, and even if the EP does not directly ablate or isolate the LAA itself, is not a good idea as the overall inflammation from the local burning in the left atrium can, and often will, inflame the inside of the LAA such that the diameter of the opened LAA appendage mouth and neck is now shrunk temporarily by up to 20%!

With a temporarily narrower LAA ostium or mouth as well as neck of the LAA due to the ablation inflammation and/or from local edema from the irrigated catheter saline discharge, you could then easily under or over size the Watchman or Amulet device selected that as a result might barely fit inside the inflamed or edemic LAA when the LAA closure device is installed during the same ablation procedure, and yet when the inflammation or edema subsides you can easily wind up with a too small, and thus poorly fitting closure device within the mouth of the LAA if you are trying to fit it into a swollen and too narrow neck and mouth during a contemporaneous AFIB ablation on the same day.

Everyone therefore suggests doing first either the LAA closure, or the AFIB ablation protocol and then follow up with a minimum of one to two months of healing for the first procedure before the second procedure is done. There are several other reasons too that favor a separate AFIB ablation procedure done one or two months before or after the LAA closure procedure as the most reliable and safest way to get long term best results.

Shannon



Edited 1 time(s). Last edit at 01/20/2017 02:24PM by Shannon.

Very interesting. Thanks for the posts.
I think many of us will need to learn more about the LLA closures options.
Now that I have my LLA velocity slowed due to an ablation, it seems there is not much I can do about it.
Most non expert EPs don't know much about this new situation of patients having the LAA slowed.
As lay people we don't have access to information about all this stuff except from forums such as this.
Being 52, it is hard to accept I will have to be on a blood thinner the rest of my life.



Edited 1 time(s). Last edit at 01/20/2017 02:39PM by gmperf.