Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation

• Published in: Journal of cardiovascular electrophysiology 2019-03, Vol.30 (3), p.339-347
• Main Authors: Mohanty, Sanghamitra, Di Biase, Luigi, Trivedi, Chintan, Choudhury, Fahim, Della Rocca, Domenico G., Romero, Jorge, Gianni, Carola, Sanchez, Javier, Hranitzky, Patrick, Gallinghouse, G. Joseph, Al‐Ahmad, Amin, Horton, Rodney P., Burkhardt, David, Natale, Andrea
• Format: Article
• Language: English
• Subjects: Ablation; Aged; Amputation; Arrhythmia; Atrial Appendage - diagnostic imaging; Atrial Appendage - physiopathology; Atrial Appendage - surgery; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Atrium; Cardiac arrhythmia; Cardiac Surgical Procedures - adverse effects; Catheters; Echocardiography; Electrocardiography; Female; Fibrillation; Humans; Ischemia; Ischemic Attack, Transient - diagnostic imaging; Ischemic Attack, Transient - etiology; left atrial appendage; Male; Medical instruments; Middle Aged; nonpulmonary vein triggers; Progression-Free Survival; Recurrence; Registries; Risk Assessment; Risk Factors; Smoke; stroke; stump; Thromboembolism; Thromboembolism - diagnostic imaging; Thromboembolism - etiology; Time Factors; transient ischemic attack
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.13825

Introduction It is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients. Methods Consecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non‐PV) triggers were ablated based on operator's discretion. Results A total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non‐PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow‐up, 126 (86.9%) patients from group I, eight (19.5%) from group II, and eight (33.3%) from group III remained arrhythmia‐free off antiarrhythmic drugs (AAD) (P