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We find somewhat puzzling the conclusions of the paper by Rillig et al.1 First, this is a small nonrandomized series. Second, the 3 patients with thromboembolic events had documented atrial fibrillation recurrence. Among those with left atrial appendage (LAA) thrombus, the recurrence rate is unclear. Thus, are the thromboembolic events related to the procedural technique itself or to atrial fibrillation recurrence? One could argue that these patients were on anticoagulation anyway. But this is not the case, the patient with a transient ischemic attack was off of anticoagulation, and among the 10 patients with LAA thrombus, one was off …

circulation. arrhythmia and electrophysiology

Letter From Briceno et al Regarding Article, “An Unexpectedly High Incidence of Stroke and Left Atrial Appendage Thrombus Formation After Electrical Isolation of the Left Atrial Appendage for the Treatment of Atrial Tachyarrhythmias”