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Simultaneous Pulsed Field Ablation and Mechanical Closure of Left Atrial Appendage Using a Novel Device.

ABSTRACT: Left atrial appendage (LAA) was shown to harbor triggers and substrate for atrial arrhythmia, electrical isolation of the LAA can be a potential treatment. We describe the use of a novel device that combines electrical isolation of the LAA using pulsed field ablation and mechanical LAA occlusion in a single procedure. (Level of Difficulty: Advanced.).

SUBMITTER: Tang M

PROVIDER: S-EPMC10544081 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Simultaneous Pulsed Field Ablation and Mechanical Closure of Left Atrial Appendage Using a Novel Device.

Tang Min M Wang Xianqing X Reddy Vivek Y VY

JACC. Case reports 20230817

Left atrial appendage (LAA) was shown to harbor triggers and substrate for atrial arrhythmia, electrical isolation of the LAA can be a potential treatment. We describe the use of a novel device that combines electrical isolation of the LAA using pulsed field ablation and mechanical LAA occlusion in a single procedure. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 37790777

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Project description:BackgroundManaging patients with atrial fibrillation (AF) and comorbid heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) is of clinical importance but a great challenge. This study aimed to evaluate the clinical benefit of the combined radiofrequency catheter ablation (RFCA) and left atrial appendage closure (LAAC) procedure in AF patients complicated with systolic HF.MethodsAF patients with HFrEF or HFmrEF who underwent the combined RFCA and LAAC procedure were prospectively enrolled in the LAACablation registry. The procedural complications and long-term outcomes were evaluated. Another cohort of AF patients with systolic HF who did not undergo either RFCA or LAAC were used for prognosis comparison.ResultsAmong 802 AF patients who underwent the combined procedure, 65 patients were comorbid with systolic HF (25 with HFrEF and 40 with HFmrEF). The overall procedural complication rate was 9.2%, which was mainly attributed to acute decompensated HF (6.2%). Accompanied with markedly reduced AF burden (from median [25th, 75th percentile]: 100 [100, 100] to 0 [0, 1.2]%, p < 0.001), upward trajectories of cardiac function were observed in 51 (78.4%) patients, showing improvement in New York Heart Classification (p < 0.01), natriuretic peptide levels (from 1492 [809, 3259] to 413 [163, 880] pg/mL, p < 0.001) and left ventricular EF (from 42.6 ± 5.3 to 53.8 ± 8.2%, p < 0.001). During the 27-month follow-up period, death, thromboembolism, major bleeding, and HF rehospitalization were observed in three, one, one, and four patients, respectively. The observed event rates showed a significant reduction compared with the non-procedure AF-HF cohort (n = 138; for composite endpoint: hazard ratio: 2.509, 95% confidence interval: 1.415-4.449, p = 0.002) and with the respective rates predicted by risk scores.ConclusionsCombining RFCA and LAAC achieves acceptable safety and credible long-term efficacy in AF patients with systolic HF. Further randomized studies are warranted in a larger patient cohort.

Dataset Information

Simultaneous Pulsed Field Ablation and Mechanical Closure of Left Atrial Appendage Using a Novel Device.

Publications

Simultaneous Pulsed Field Ablation and Mechanical Closure of Left Atrial Appendage Using a Novel Device.

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