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Left atrial appendage isolation

Toshiya Ohtsuka, Takahiro Nonaka, Motoyuki Hisagi, Mikio Ninomiya
BACKGROUND: We evaluated the safety and rhythm-control effectiveness in en bloc isolation of the left pulmonary vein (PV) and appendage conducted as part of the thoracoscopic procedure for bilateral PV isolation, non-PV ablation, and appendage closure for atrial fibrillation (AF). METHODS: Procedural safety was evaluated by reviewing the surgical records. The rhythm-control was examined in accordance with the Heart Rhythm Society guidelines at postoperative months 1, 3, 6, and 12 and yearly thereafter...
August 14, 2018: Annals of Thoracic Surgery
Georgios Giannopoulos, Vasileios Kekeris, Dimitrios Vrachatis, Charalampos Kossyvakis, Charalampos Ntavelas, Georgios Tsitsinakis, Athanasios Koutivas, Christos Tolis, Christos Angelidis, Spyridon Deftereos
BACKGROUND: Left atrial appendage (LAA) functional modification in the context of pulmonary vein isolation has been a focus point of research and LAA emptying flow velocity (LAAEFV) is considered to reflect LAA contractility, stunning, and fibrosis. OBJECTIVE: In the present study, we sought to prospectively evaluate short-term LAAEFV changes after radiofrequency (RF) or cryoballoon ablation in paroxysmal AF. METHODS: This was a prospective substudy of the Effect of Cryoballoon and RF Ablation on Left Atrial Function (CryoLAEF) study (ClinicalTrials...
July 20, 2018: Pacing and Clinical Electrophysiology: PACE
Heiko Lehrmann, Amir S Jadidi, Jan Minners, Juan Chen, Björn Müller-Edenborn, Reinhold Weber, Olaf Dössel, Thomas Arentz, Axel Loewe
OBJECTIVES: This study hypothesized that P-wave morphology and timing under left atrial appendage (LAA) pacing change characteristically immediately upon anterior mitral line (AML) block. BACKGROUND: Perimitral flutter commonly occurs following ablation of atrial fibrillation and can be cured by an AML. However, confirmation of bidirectional block can be challenging, especially in severely fibrotic atria. METHODS: The study analyzed 129 consecutive patients (66 ± 8 years, 64% men) who developed perimitral flutter after atrial fibrillation ablation...
July 2018: JACC. Clinical Electrophysiology
Mohammad Sahebjam, Vahide Montazeri, Arezoo Zoroufian, Ali Hosseinsabet, Masoumeh Lotfi-Tokaldany, Arash Jalali
AIM: We intended to assess the left atrial deformation parameters, using two-dimensional speckle tracking (2DSTE) and transesophageal echocardiography (TEE), and determine the correlation between these two techniques in order to recognize the patients at risk for cardioembolic events. METHOD: Strain and strain rate were measured using 2DSTE among 26 patients in sinus rhythm, with isolated moderate to severe mitral stenosis. Left atrial (LA) volume parameters (maximum, minimum and preatrial contraction) were measured...
July 3, 2018: Echocardiography
Jorge Romero, Andrea Natale, Luigi Di Biase
No abstract text is available yet for this article.
May 24, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Shyam Kumar Singh Thingnam, Sachin Mahajan, Vikas Kumar
Background Percutaneous device closure of an ostium secundum atrial septal defect is associated with excellent outcomes and cosmetic results but at the cost of occasional serious and sometimes fatal complications as well as lifelong follow-up. Surgical intervention is required in cases of device-related complications, which carries a slightly higher risk compared to primary closure of an atrial septal defect. We present a surgical perspective of device closure of atrial septal defect. Methods Our database was searched over 4 years for complications related to percutaneous device closure of atrial septal defect, which required surgical retrieval of the device and closure of the defect...
June 2018: Asian Cardiovascular & Thoracic Annals
Yukun Cao, Tin Yang, Ma Hou, Hongcha Zhang, Xi Chen, Fe Zou
Partial anomalous pulmonary venous connection (PAPVC) is an uncommon congenital heart disease, which may be difficult to identify and often remains undiagnosed. Accurate diagnosis of major aortopulmonary collaterals and partial anomalous pulmonary venous drainage in patients with congenital heart disease is important but problematic. The goal of this publication is to present the diagnosis and surgical repair of this rare pathology in an eight-year-old boy. Atrial septal defect was found by echocardiography, but no anomalous pulmonary vein was found...
March 8, 2018: Heart Surgery Forum
Faraz Pathan, Harvey Hecht, Jagat Narula, Thomas H Marwick
Evaluation of the left atrium and left atrial appendage for the presence of thrombus prior to cardioversion and pulmonary vein isolation, and of the entire heart for embolic sources in the setting of cryptogenic stroke, has long been standard medical care. Guidelines have uniformly recommended transesophageal echocardiography (TEE) to accomplish these goals. In recent years, computed tomographic angiography has demonstrated diagnostic accuracy similar to that of TEE for the detection of thrombus. Analysis of the pertinent data and relative merits of the 2 technologies leads to the conclusions that: 1) both modalities have some unique, nonoverlapping capabilities that may dictate their use in specific situations; 2) computed tomographic angiography is a reasonable alternative to TEE when the primary aim is to exclude left atrial and left atrial appendage thrombus and in patients in whom the risks associated with TEE outweigh the benefits; and 3) both options should be discussed with the patient in the setting of shared decision making...
April 2018: JACC. Cardiovascular Imaging
Roland R Tilz, Charlotte Eitel
No abstract text is available yet for this article.
January 2018: JACC. Clinical Electrophysiology
Daniel J Friedman, Eric W Black-Maier, Adam S Barnett, Sean D Pokorney, Sana M Al-Khatib, Kevin P Jackson, Tristram D Bahnson, Christopher R Ellis, Brett D Atwater, Robert K Lewis, Jonathan P Piccini
OBJECTIVES: In this study, the authors sought to perform a meta-analysis of controlled studies assessing the relationship between left atrial appendage (LAA) electrical isolation (EI) and recurrent atrial fibrillation (AF). BACKGROUND: LAA triggers could play an important role in AF and can be treated with complete EI of the LAA via surgical or percutaneous approaches. METHODS: We conducted a meta-analysis of all controlled studies published as of November 21, 2016, assessing the relationship between left atrial appendage electrical isolation (LAAEI) and recurrent AF...
January 2018: JACC. Clinical Electrophysiology
Markus Linhart, Jessica T Werner, Florian Stöckigt, Annika T Kohlmann, Pia C Lodde, Lutz P T Linneborn, Thomas Beiert, Christoph Hammerstingl, Roger Borràs, Georg Nickenig, René P Andrié, Jan W Schrickel
PURPOSE: Congenital atrial septal defect (ASD) is associated with increased morbidity, whereas little is known about the rate of spontaneous closure, associated clinical and echocardiographic parameters, or complications of iatrogenic atrial septal defect (iASD) beyond 1 year of follow-up. Persistent iASD after transseptal puncture for PVI has been described in up to 38% of small cohorts of patients in short-term follow-up after transseptal puncture. We sought to investigate the course of iASD after single transseptal puncture for first pulmonary vein isolation (PVI) with cryoballoon, along with possible risk factors for persistent iASD...
July 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Alessandro Satriano, Edward J Vigmond, David S Schwartzman, Elena S Di Martino
Mechanical stretch plays a major role in modulating atrial function, being responsible for beat-by-beat responses to changes in chamber preload, enabling a prompt regulation of cardiac function. Mechano-electric coupling (MEC) operates through many mechanisms and has many targets, making it experimentally difficult to isolate causes and effects especially under sinus conditions where effects are more transient and subtle. Therefore, modelling is a powerful tool to help understand the role of MEC with respect to the atrial electromechanical interaction...
May 1, 2018: Computers in Biology and Medicine
Yoshinari Enomoto, Go Hashimoto, Naohiko Sahara, Hikari Hashimoto, Hiroki Niikura, Keijiro Nakamura, Raisuke Iijima, Hidehiko Hara, Makoto Suzuki, Mahito Noro, Masao Moroi, Kaoru Sugi, Masato Nakamura
A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected...
March 30, 2018: International Heart Journal
Grzegorz Suwalski, Robert Emery, Jakub Mróz, Kamil Kaczejko, Leszek Gryszko, Andrzej Cwetsch, Andrzej Skrobowski
OBJECTIVES: In patients undergoing cardiac surgical procedures, pulmonary vein isolation may be easily accomplished, and it is important to achieve bidirectional conduction block across created lesions. The primary aim of this study was to assess the risk of pulmonary vein stenosis (PVS) after multiple applications of epicardial bipolar radiofrequency energy. METHODS: Thirty-five consecutive patients who were referred for off-pump coronary revascularization with concomitant pulmonary vein isolation and left atrial appendage occlusion were prospectively included in the study...
August 1, 2018: Interactive Cardiovascular and Thoracic Surgery
Albert C Lin, Bradley P Knight
Interventional catheter ablation approaches to the rhythm control of atrial fibrillation (AF) have advanced significantly in the past decade. The foundation of the catheter ablation in AF is electrical isolation of the pulmonary veins (PVI). However, PVI only in more advanced stages of AF (persistent AF) has only modest to poor success rates prompting a search for alternative and adjunctive procedures to improve the outcomes of ablation in persistent AF. The left atrial appendage (LAA) is well understood to be a primary source of emboli in AF but less well known be a trigger or driver for AF...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Sandeep Prabhu, Manish Kalla, Kah Y Peck, Aleksandr Voskoboinik, Alex J A McLellan, Bupesh Pathik, Chrishan J Nalliah, Geoff R Wong, Hariharan Sugumar, Sonia M Azzopardi, Geoffrey Lee, Liang-Han Ling, Jonathan M Kalman, Peter M Kistler
BACKGROUND: Pulmonary vein (PV) isolation (PVI) remains the cornerstone of catheter ablation (CA) in persistent atrial fibrillation (AF) (PeAF), although less successful than for paroxysmal AF. Whether rapid or fibrillatory (PV AF) PV firing may identify patients with PeAF more likely to benefit from a PV-based ablation approach is unclear. OBJECTIVE: The purpose of this study was to determine the relationship between the PV cycle length (PVCL) and the PV AF outcome after CA...
July 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Karl M Reyes, Dipankar Gupta, Frederick Jay Fricker, Susan Cooke, Mark S Bleiweis
Orthotopic heart transplantation in patients with an isolated persistent left superior vena cava is extremely rare, and the anastomotic connection between a right-sided donor superior vena cava and left-sided recipient superior vena cava can be challenging to perform. We present a novel technique used in an infant female, using the left atrial appendage to extend the superior vena cava anastomosis.
June 2018: Annals of Thoracic Surgery
Lara M Vos, Dipak Kotecha, Guillaume S C Geuzebroek, Frederik N Hofman, Wim Jan P van Boven, Johannes Kelder, Bas A J M de Mol, Bart P van Putte
Aims: Thoracoscopic surgical ablation has evolved into a successful strategy for symptomatic atrial fibrillation (AF) refractory to other therapy. More widespread referral is limited by the lack of information on potential complications. Our aim was to systematically evaluate 30-day complications of totally thoracoscopic surgical ablation. Methods and results: We retrospectively studied consecutive patients undergoing totally thoracoscopic surgical ablation at a referral centre in the Netherlands (2007-2016)...
January 18, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Jorge Romero, Gregory F Michaud, Ricardo Avendano, David F Briceño, Saurabh Kumar, Juan Carlos Diaz, Sanghamitra Mohanty, Chintan Trivedi, Carola Gianni, Domenico Della Rocca, Riccardo Proietti, Laura Perrotta, Stefano Bordignon, Julian K R Chun, Boris Schmidt, Mario Garcia, Andrea Natale, Luigi Di Biase
Aims: The long-term outcomes of left atrial appendage electrical isolation (LAAEI) in patients with non-paroxysmal atrial fibrillation (AF) have corroborated the significant role of the LAA in this arrhythmia. We sought to investigate the incremental benefit of LAAEI in patients undergoing catheter ablation for persistent AF or long-standing persistent AF (LSPAF). Methods and results: A systematic review of Medline, Cochrane, and Embase for all the clinical studies in which assessment LAAEI in non-paroxysmal AF patients was performed...
January 12, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Jose M Sanchez, Ghannam Al-Dosari, Sherman Chu, Ramin Beygui, Tobias Deuse, Nitish Badhwar, Randall J Lee
Atrial fibrillation (AF) is the most common cardiac arrhythmia. The incidence of AF increases with age and is associated with increased stroke, heart failure and mortality. Persistent and long standing persistent AF is difficult to treat and often refractory to medical therapy and catheter ablation. Areas covered: This article reviews the historical development of the surgical Cox-MAZE procedure and current hybrid and minimally invasive surgical approaches for the treatment of persistent and long standing persistent AF...
February 2018: Expert Review of Cardiovascular Therapy
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