Combination of percutaneous left appendage epicardial ligation and endo-epicardial atrial fibrillation ablation

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Chiara Pintor¹  Alessandro Blandino²  Antonino Tomasello²  Giuseppe Musumeci²  Stefano Grossi²  Francesca Bianchi²  Barbara Mabritto² 

[1] Biosense Webster Italy, Johnson&Johnson MedTech Italy, Pomezia (RM), Italy;Cardiology Department, AO Ordine Mauriziano, Turin, Italy;

关键词: atrial fibrillation ablation;    epicardial ablation;    left appendage occlusion;    left appendage ligation;    transcatheter ablation;   

DOI  :  10.3389/fcvm.2023.1224924

 received in 2023-05-18, accepted in 2023-09-11,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionAtrial fibrillation (AF) is the main cause of cardioembolic stroke. In high-bleeding-risk patients, long-life anticoagulation therapy is not permitted, and left atrial appendage (LAA) closure may be considered. LAA is also a critical substrate for AF. Epicardial LAA occlusion has several advantages: LAA ligation results in a favorable electrical and structural atrial remodeling, which decreases AF recurrence. Endocardial ablation alone is not efficient for all patients, and new evidence shows better outcomes in patients affected by persistent AF after a combined hybrid endo-epicardial ablation. Considering the synergic potential of these techniques, in this case series, they were both combined in a single procedure.Methods and resultsWe describe the treatment of 5 patients referred for refractory AF ablation and LAA closure. All patients had high thrombotic and previous major hemorrhage, with relative contraindication to life-long therapy with anticoagulation. A combined procedure of LAA ligation and endo-epicardial ablation was scheduled with short-term anticoagulation. LAA closure was performed with an epicardial approach using the LARIAT system. Then, LA mapping and ablation were performed, endocardially and then epicardially.All procedures were concluded without complications.At follow-up, in all patients, transesophageal echocardiography showed the complete occlusion of the LAA; therefore, anticoagulation therapy was interrupted. All patients were asymptomatic, and in the sinus rhythm, no hemorrhage or ischemic events occurred.ConclusionThe combination of percutaneous LAA ligation and endo-epicardial ablation was revealed to be feasible and safe and might represent a new approach for the treatment of refractory AF in patients with indication of LAA occlusion.

【 授权许可】

Unknown   
© 2023 Grossi, Bianchi, Blandino, Pintor, Tomasello, Mabritto and Musumeci.