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Mid-term outcomes of concomitant left atrial appendage closure and catheter ablation for non-valvular atrial fibrillation: a multicenter registry

  • Fang-zhou Liu
  • Wei-dong Lin
  • Hong-tao Liao
  • Jian Peng
  • Yu-mei Xue
  • Xian-zhang Zhan
  • Jie-ming Zhu
  • Kai-hang Yiu
  • Yi-fu Li
  • Hung-fat Tse
  • Li Shi
  • Xian-hong FangEmail author
  • Shu-lin WuEmail author
Original Article

Abstract

To investigate the safety and midterm outcome of concomitant left atrial appendage (LAA) closure and catheter ablation (CA) as a one-stage hybrid procedure for non-valvular atrial fibrillation (AF) in a multicenter registry. A total of 50 consecutive patients with symptomatic drug-resistant non-valvular AF with CHA2DS2-VASc score ≥ 2 and contraindications for antithrombotic therapy were included in the prospectively established LAA closure registry, and underwent concomitant LAA closure (48 for WATCHMAN and 2 for ACP) and CA procedure (40 for radiofrequency and 10 for cryoballoon CA). Two cardiac tamponades, one peripheral vascular complications and one mild air embolism were observed during perioperative period. After mean follow-up of 20.2 ± 11.5 months, 18 (36%) patients presented with atrial arrhythmia relapse and 45 (91.8%) patients presented with complete sealing; furthermore, there were two transient ischemic attacks and one ischemic stroke under an off-oral anticoagulant situation, respectively. Concomitant CA and LAA closure as a one-stage hybrid procedure might be feasible and potentially decrease costs in patients with symptomatic non-valvular AF with high stroke risk and contraindication to antithrombotic treatment, and as safe as LAA closure procedure only during the perioperative period. However, it was necessary to further validate the mid-term safety.

Keywords

Atrial fibrillation Left atrial appendage closure Catheter ablation Concomitant 

Abbreviations

AF

Atrial fibrillation

CA

Catheter ablation

LAA

Left atrial appendage

OAC

Oral anticoagulant

TEE

Transesophageal echocardiography

LVEF

Left ventricular ejection fraction

ACP

Amplatzer cardiac plug

PV

Pulmonary vein

ECV

Electric cardioversion

AADs

Antiarrhythmic drugs

TIA

Transient ischemic attack

AA

Atrial arrhythmia

Notes

Acknowledgements

Special thanks to Xuan Jiang M.D. for the statistical analysis to this article and David Cushley M.D. Ph.D. for language editing.

Funding

This work was supported by National Nature Science Foundation of China (no. 81370295), Science and Technology Program of Guangdong Province, China (no. 2017A020215054), Investigator sponsored research Grant from Boston scientific (IRF no. 20161216001), Science and Technology Planning of Guangzhou City, China (no. 2014B070705005).

Compliance with ethical standards

Conflict of interest

Prof. Shu-lin Wu received research grants from Boston scientific and Biosense Webster. No financial disclosures for the other author.

References

  1. 1.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, ESC Scientific Document Group (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962CrossRefGoogle Scholar
  2. 2.
    Al-Saady NM, Obel OA, Camm AJ (1999) Left atrial appendage: structure, function, and role in thromboembolism. Heart 82:547–554CrossRefGoogle Scholar
  3. 3.
    Zhan XZ, Lin WD, Liu FZ, Xue YM, Liao HT, Li X, Fang XH, Deng H, Huang J, Li YQ, Hai JJ, Tse HF, Wu SL (2018) Predictive value of red cell distribution width on left atrial thrombus or left atrial spontaneous echo contrast in patients with non-valvular atrial fibrillation. J Geriatr Cardiol 15:408–412PubMedPubMedCentralGoogle Scholar
  4. 4.
    Liu FZ, Liao HT, Lin WD, Xue YM, Zhan XZ, Fang XH, Rao F, Deng H, Huang J, Hai JJ, Tse HF, Wu SL (2018) Predictive effect of hyperuricemia on left atrial stasis in non-valvular atrial fibrillation patients. Int J Cardiol 258:103–108CrossRefGoogle Scholar
  5. 5.
    Liao HT, Liu FZ, Xue YM, Zhan XZ, Fang XH, Huang J, Wei W, Rao F, Deng H, Liu Y, Lin WD, Wu SL (2015) Predictive value of serum uric acid on left atrial spontaneous echo contrast in non-valvular atrial fibrillation patients. J Geriatr Cardiol 12:641–646PubMedPubMedCentralGoogle Scholar
  6. 6.
    Kuang RR, Liu FZ, Li YP, Lin WD, Liang HS, Chen AH (2017) Hemoglobin A1c and risk of left atrial thrombus and spontaneous echo contrast in non-valvular atrial fibrillation patients. Eur J Med Res 22:15CrossRefGoogle Scholar
  7. 7.
    Alipour A, Swaans MJ, van Dijk VF, Balt JC, Post MC, Bosschaert MAR, Rensing BJ, Reddy VY, Boersma LVA (2015) Ablation for atrial fibrillation combined with left atrial appendage closure. JACC Clin Electrophysiol 1:486–495CrossRefGoogle Scholar
  8. 8.
    Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383:955–962CrossRefGoogle Scholar
  9. 9.
    Samsa GP, Matchar DB, Goldstein LB, Bonito AJ, Lux LJ, Witter DM, Bian J (2000) Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities. Arch Intern Med 160:967–973CrossRefGoogle Scholar
  10. 10.
    Boersma LV, Schmidt B, Betts TR, Sievert H, Tamburino C, Teiger E, Pokushalov E, Kische S, Schmitz T, Stein KM, Bergmann MW, EWOLUTION Investigators (2016) Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry. Eur Heart J 37:2465–2474CrossRefGoogle Scholar
  11. 11.
    Reddy VY, Doshi SK, Sievert H, Buchbinder M, Neuzil P, Huber K, Halperin JL, Holmes D, PROTECT AF Investigators (2013) Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-year follow-up of the PROTECT AF (watchman left atrial appendage system for embolic protection in patients with atrial fibrillation) trial. Circulation 127:720–729CrossRefGoogle Scholar
  12. 12.
    Reddy VY, Sievert H, Halperin J, Doshi SK, Buchbinder M, Neuzil P, Huber K, Whisenant B, Kar S, Swarup V, Gordon N, Holmes D, PROTECT AF Steering Committee and Investigators (2014) Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA 312:1988–1998CrossRefGoogle Scholar
  13. 13.
    Calvo N, Salterain N, Arguedas H, Macias A, Esteban A, Garcia de Yebenes M, Gavira JJ, Barba J, Garcia-Bolao I (2015) Combined catheter ablation and left atrial appendage closure as a hybrid procedure for the treatment of atrial fibrillation. Europace 17:1533–1540CrossRefGoogle Scholar
  14. 14.
    Romanov A, Pokushalov E, Artemenko S, Yakubov A, Stenin I, Kretov E, Krestianinov O, Grazhdankin I, Risteski D, Karaskov A, Steinberg JS (2015) Does left atrial appendage closure improve the success of pulmonary vein isolation? Results of a randomized clinical trial. J Interv Card Electrophysiol 44:9–16CrossRefGoogle Scholar
  15. 15.
    Phillips KP, Walker DT, Humphries JA (2016) Combined catheter ablation for atrial fibrillation and Watchman(R) left atrial appendage occlusion procedures: Five-year experience. J Arrhythm 32:119–126CrossRefGoogle Scholar
  16. 16.
    Fassini G, Conti S, Moltrasio M, Maltagliati A, Tundo F, Riva S, Dello Russo A, Casella M, Majocchi B, Zucchetti M, Russo E, Marino V, Pepi M, Tondo C (2016) Concomitant cryoballoon ablation and percutaneous closure of left atrial appendage in patients with atrial fibrillation. Europace 18:1705–1710CrossRefGoogle Scholar
  17. 17.
    Swaans MJ, Post MC, Rensing BJ, Boersma LV (2012) Ablation for atrial fibrillation in combination with left atrial appendage closure: first results of a feasibility study. J Am Heart Assoc 1:e002212CrossRefGoogle Scholar
  18. 18.
    Liu FZ, Liao HT, Liu J, Xue YM, Zhan XZ, Lin WD, Guo HM, Wu SL (2018) Automated Ultra-High Density Mapping in atrial fibrillation hybrid procedure. J Geriatr Cardiol 15:379–381PubMedPubMedCentralGoogle Scholar
  19. 19.
    Ouyang F, Tilz R, Chun J, Schmidt B, Wissner E, Zerm T, Neven K, Kokturk B, Konstantinidou M, Metzner A, Fuernkranz A, Kuck KH (2010) Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation 122:2368–2377CrossRefGoogle Scholar
  20. 20.
    Tilz RR, Rillig A, Thum AM, Arya A, Wohlmuth P, Metzner A, Mathew S, Yoshiga Y, Wissner E, Kuck KH, Ouyang F (2012) Catheter ablation of long-standing persistent atrial fibrillation: 5-year outcomes of the Hamburg sequential ablation strategy. J Am Coll Cardiol 60:1921–1929CrossRefGoogle Scholar
  21. 21.
    Wintgens L, Romanov A, Phillips K, Ballesteros G, Swaans M, Folkeringa R, Garcia-Bolao I, Pokushalov E, Boersma L (2018) Combined atrial fibrillation ablation and left atrial appendage closure: long-term follow-up from a large multicentre registry. Europace.  https://doi.org/10.1093/europace/euy025 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouPeople’s Republic of China
  2. 2.Department of Cardiology, Atrial Fibrillation Center, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople’s Republic of China
  3. 3.Division of CardiologyThe Third Hospital Affiliated Sun Yat-sen UniversityGuangzhouPeople’s Republic of China
  4. 4.Cardiology Division, Department of MedicineQueen Mary HospitalHong KongPeople’s Republic of China
  5. 5.Division of Cardiology, Department of MedicineShenzhen HospitalShenzhenPeople’s Republic of China
  6. 6.Cardiology Division, Atrial Fibrillation CenterSun Yat-sen Cardiovascular HospitalShenzhenPeople’s Republic of China
  7. 7.Cardiology DivisionZhuhai People’s HospitalZhuhaiPeople’s Republic of China

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