Open AccessAblation for Atrial Fibrillation in Combination With Left Atrial Appendage Closure: First Results of a Feasibility Study
Author(s) -
Swaans Martin J.,
Post Martijn C.,
Rensing Benno J.W.M.,
Boersma Lucas V.A.
Publication year - 2012
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.112.002212
Subject(s) - medicine , contraindication , atrial fibrillation , ablation , cardiology , catheter ablation , stroke (engine) , surgery , alternative medicine , pathology , mechanical engineering , engineering
Background Drug‐refractory atrial fibrillation ( AF ) increasingly is being treated with catheter ablation. However, the long‐term success rate, expressed as freedom from AF , is <50%. Therefore, vitamin K antagonists, with all their complications, remain necessary. Recently, left atrial appendage ( LAA ) occlusion devices were introduced as an alternative to vitamin K antagonists. Here, we investigated whether AF ablation and LAA occlusion could be a feasible and safe combination in patients with symptomatic drug‐refractory AF and a CHADS 2 score ≥1 or a contraindication for vitamin K antagonists.Methods and Results Ablation was performed by using multielectrode catheters with phased radiofrequency energy. LAA was occluded with the Watchman device (Atritech, Inc, Plymouth, MN). Between February 2010 and February 2011, 30 patients were treated (21 male; age, 62.8±8.5 years). Median CHADS 2 score was 2.5 (25th to 75th percentiles: 2 to 3), median CHADS ‐ VAS c score was 3 (25th to 75th percentiles: 3 to 5), 77% had prior stroke, and 27% had a contraindication for vitamin K antagonists. Median HAS ‐ BLED score was 2 (range, 1 to 5). Successful device implantation was achieved with a median number of 1.5 devices (median diameter 24 mm [25th to 75th percentiles: 24 to 24 mm]). Total procedure time was 97 minutes (25th to 75th percentiles: 75 to 115 minutes). At 60 days, all patients met the criteria for successful sealing. Follow‐up visit at 12 months showed a 30% rate of documented recurrence of AF . A repeated pulmonary vein isolation was performed successfully in 4 patients, without interference of the LAA closure device. No thromboembolic events occurred during 1‐year follow‐up.Conclusion LAA occlusion with the Watchman device and AF ablation can be combined successfully and safely in a single procedure. The Watchman does not interfere with a repeated ablation.