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Concomitant Left Atrial Appendage Closure and Catheter Ablation of Atrial Fibrillation

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Left Atrial Appendage Closure

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Electrical disconnection of pulmonary veins (PV) is regarded as the cornerstone to treat atrial fibrillation (AF) by means of transcatheter ablation [1–4]. This target can be achieved by conventional point-to-point radiofrequency current delivery with an irrigated tip electrode catheter or, more recently, by using cryoenergy through a specific balloon designed platform. Furthermore, AF is probably the most challenging arrhythmia to treat in the general population, due to the unsatisfactory efficacy provided by drug treatment in the long term and the high risk of thromboembolic event [5–8]. It is reported that the overall annual risk of stroke is 5 % in patients suffering from AF and, increasing up to 15 % in very high-risk patients [9]. The left atrial appendage (LAA) is undoubtedly the main source of thrombus formation in patients with non-valvular AF, as autopsies and echocardiography studies have revealed [10]. According to international guidelines, anticoagulation treatment needs to be prescribed to patients with CHA2DS2-VASc score ≥1 to prevent embolic events [11]. In clinical practice, the administration of vitamin K antagonists (VKA) or novel oral anticoagulants (NOACs) can carry some critical disadvantages, such as profuse and frequent bleeding, noncompliance, difficulty keeping in a therapeutic range and frequent interactions with some dietary components and medications [12–14]. All these reasons can lead to undertreatment of patients, especially elderly patients who have high propensity to major hemorrhage [15, 16] associated with thromboembolic risk.

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Authors and Affiliations

  1. Department of Cardiovascular Sciences, Centro Cardiologico Monzino, Cardiac Arrhythmia Research Center, University of Milan, 4 Via Carlo Parea, Milan, 20138, Italy

    Claudio Tondo M.D., Ph.D. & Gaetano Fassini M.D.

Authors
  1. Claudio Tondo M.D., Ph.D.
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  2. Gaetano Fassini M.D.
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Correspondence to Claudio Tondo M.D., Ph.D. .

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Editors and Affiliations

  1. Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

    Jacqueline Saw

  2. Cardiovascular Intervention Center Research, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Saibal Kar

  3. Scripps Translational Science Institute, Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA

    Matthew J. Price

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Tondo, C., Fassini, G. (2016). Concomitant Left Atrial Appendage Closure and Catheter Ablation of Atrial Fibrillation. In: Saw, J., Kar, S., Price, M. (eds) Left Atrial Appendage Closure. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-16280-5_17

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  • DOI: https://doi.org/10.1007/978-3-319-16280-5_17

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-16279-9

  • Online ISBN: 978-3-319-16280-5

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