Atrial fibrillation ablation beyond pulmonary veins: The role of left atrial appendage

• Main Authors: Jorge Romero, Andrea Natale, Luigi Di Biase
• Format: Article
• Language: English
• Published: Elsevier 2017-11-01
• Series: Revista Portuguesa de Cardiologia (English Edition)
• Online Access: http://www.sciencedirect.com/science/article/pii/S217420491730363X

The role of pulmonary vein isolation in patients with non-paroxysmal atrial fibrillation (AF) is only modest. Several studies have demonstrated the role of the left atrial appendage (LAA) in initiating and maintaining of this arrhythmia. We review in this article the incremental benefit in free-arrhythmia recurrence of LAA electrical isolation in patients undergoing procedures for persistent AF or long standing persistent AF either using radiofrequency ablation, cryoablation or Lariat device implantation. Likewise, acute complications, anticoagulation and the risk of ischemic stroke after LAA electrical isolation (LAAEI) are analyzed. LAAEI in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from all atrial arrhythmias in patients with persistent AF and long standing persistent atrial fibrillation (LSPAF) without increasing acute procedural complications and without raising the risk of ischemic stroke. Keywords: Persistent atrial fibrillation, Long standing persistent atrial fibrillation, Left atrial appendage, Radiofrequency ablation, Cryoablation, LARIAT device