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Practical Applications of Concomitant Pulmonary Vein Isolation and Left Atrial Appendix Closure Device Implantation.

ABSTRACT: Pulmonary vein isolation (PVI) using cryoballoon causes acute tissue edema of the osteal region of the pulmonary veins and the left atrium. In two cases combining PVI with an implantation of a left atrial appendage closure device led to malsizing of the device, device shouldering, and a paraprosthetic residual flow. (Level of Difficulty: Advanced.).

SUBMITTER: van Rijn D

PROVIDER: S-EPMC8446027 | biostudies-literature | 2021 Sep

REPOSITORIES: biostudies-literature

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Practical Applications of Concomitant Pulmonary Vein Isolation and Left Atrial Appendix Closure Device Implantation.

van Rijn Dafne D Hendriks Astrid A AA Noten Anne-Marie M E AME van Heerebeek Loek L Khan Muchtiar M

JACC. Case reports 20210915 12

Pulmonary vein isolation (PVI) using cryoballoon causes acute tissue edema of the osteal region of the pulmonary veins and the left atrium. In two cases combining PVI with an implantation of a left atrial appendage closure device led to malsizing of the device, device shouldering, and a paraprosthetic residual flow. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 34557681

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Project description:BackgroundThe combined procedure of left atrial appendage closure (LAAC) with concomitant pulmonary vein isolation (PVI) has demonstrated its efficacy and safety. However, there is still a lack of comparative investigations regarding the long-term benefits of the combined procedure when compared to LAAC alone. Our study aims to assess the long-term outcomes of combined procedure of LAAC with concomitant PVI in comparison with a propensity matched LAAC alone group.MethodsPropensity score matching (PSM) was employed to rectify covariate imbalances, resulting in the inclusion of 153 comparable patients from the initial cohort of 333 non-valvular atrial fibrillation (AF) patients. Clinical outcomes, encompassing thrombotic events, major cardiocerebrovascular adverse events (MACCE), re-hospitalization due to cardiovascular disease (CVD), and atrial tachycardia (AT), were juxtaposed between the two groups. Bleeding events and peri-device complications, such as residual flow, device-related thrombus, and device replacement, were also compared. Additionally, a patients group underwent PVI alone was included for comparing AF recurrence rates between the PVI alone group and the combined group.ResultsFollowing PSM, 153 patients (mean age 70.3 ± 8.9, 62.7% men) were included, with 102 undergoing the combined procedure and 51 undergoing LAAC alone. No significant differences were found in baseline characteristics between the two groups. The mean follow-up time was 37.6 ± 7.9 months, and two patients were lost to follow-up in the combined procedure group. Thrombotic events were observed in 4 (7.8%) patients in the LAAC alone group and 4 (4.0%) in the combined group (Log-rank p = 0.301). The proportion of patients experiencing MACCE, re-hospitalization due to CVD, and AT between the two groups was comparable, as were bleeding events and peri-device complications. Among patients from the combined procedure group without AF recurrence, a significant difference was noted in prior-procedure left ventricular ejection fraction (LVEF) and LVEF at the 12th month after the procedure (57.2% ± 7.1% vs. 60.5% ± 6.5%, p = 0.002).ConclusionThe concomitant PVI and LAAC procedure did not increase procedure-related complications, nor did it confer significant benefits in preventing thrombotic events or reducing other cardiovascular events. However, the combined procedure improved heart function, suggesting potential long-term benefits.

Dataset Information

Practical Applications of Concomitant Pulmonary Vein Isolation and Left Atrial Appendix Closure Device Implantation.

Publications

Practical Applications of Concomitant Pulmonary Vein Isolation and Left Atrial Appendix Closure Device Implantation.

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