Left atrial appendage closure device implantation and pulmonary vein isolation as a comprehensive treatment for atrial fibrillation

• Main Authors: А. А. Якубов, А. Б. Романов, С. Н. Артеменко, Д. В. Лосик, В. В. Шабанов, Д. А. Елесин, А. Г. Стрельников, И. Г. Стенин, С. А. Абашкин, Е. А. Покушалов
• Format: Article
• Language: Russian
• Published: Meshalkin National Medical Research Center 2016-01-01
• Series: Патология кровообращения и кардиохирургия
• Subjects: Фибрилляция предсердий; Аблация; Окклюдер ушка левого предсердия; Имплантируемый монитор для непрерывного контроля сердечного ритма
• Online Access: http://journalmeshalkin.ru/index.php/heartjournal/article/view/272

<p>Objective. This randomized clinical trial was designed to assess the impact of pulmonary vein isolation (PVI) combined with LAA occlusion on patients with high-risk AF. <br />Methods. Patients with a history of symptomatic paroxysmal (P) AF and/or persistent (Pers) AF and CHA2DS2-VASc score ≥2 and HAS-BLED score ≥3 were randomized in groups with PVI only (n = 44) and PVI combined with LAA occlusion (n = 45). All patients were followed during 24 months in order to evaluate the safety of thromboembolic complications and to monitor the heart rhythm conducted by means of an implantable cardiac monitor. <br />Results. 6 patients from the PVI with LAA occlusion group were transferred to the PVI only group because of a failure to implant a LAA closure device. Based on ILR data, by the end of the follow-up 33 (66%) out of 50 patients in the PVI only group and 23 (59%) out of 39 patients in the PVI with LAA closure device implantation group were free from atrial fibrillation and flutter without antiarrhythmic drugs (p = 0.34). In the blanking period, AF% was significantly higher in the PVI with LAA closure group than that in the PVI-only group, 9.7±10.8 and 4.2±4.1% respectively (p = 0.004). After the blanking period, the AF% was similar in both groups. During the entire follow-up, no AF/intervention-related complications were observed. <br />Conclusion. The combination of LAA closure device implantation with PVI seems to be a safe procedure. However, it does not improve the efficacy of PVI in patients with symptomatic refractory AF. But in the blanking period LAA occlusion increases AF %.</p>