One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure
Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure....
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| Published in | Chinese medical journal Vol. 133; no. 12; pp. 1422 - 1428 |
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| Main Authors | , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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China
The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license
20.06.2020
Lippincott Williams & Wilkins Ovid Technologies Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China Wolters Kluwer Health Wolters Kluwer |
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| Abstract | Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.
Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.
A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed.
Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population. |
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| AbstractList | BackgroundCatheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.MethodsConsecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.ResultsA total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed.ConclusionCombining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population. Background. Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure. Methods. Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively. Results. A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed. Conclusion. Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population. Background::Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.Methods::Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.Results::A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA 2DS 2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed. Conclusion::Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population. Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure. Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively. A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed. Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population. Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.BACKGROUNDCatheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.METHODSConsecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed.RESULTSA total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed.Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.CONCLUSIONCombining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population. |
| Abstract_FL | Background::Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.Methods::Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.Results::A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA
2DS
2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed.
Conclusion::Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population. |
| Author | Wang, Qun-Shan Mo, Bin-Feng Li, Wei Lu, Qiu-Fen Zhang, Peng-Pai Feng, Xiang-Fei Sun, Jian Wang, Zhi-Quan Yu, Yi-Chi Liu, Bo Yang, Mei Gong, Chang-Qi Zhao, Ming-Zhe Chen, Mu Yu, Ying Zhang, Rui Zhao, Yan Li, Yi-Gang |
| AuthorAffiliation | Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China |
| AuthorAffiliation_xml | – name: Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China |
| Author_FL | Mo Bin-Feng Chen Mu Zhang Rui Wang Qun-Shan Zhang Peng-Pai Zhao Yan Yang Mei Zhao Ming-Zhe Lu Qiu-Fen Feng Xiang-Fei Yu Ying Wang Zhi-Quan Sun Jian Li Yi-Gang Liu Bo Gong Chang-Qi Yu Yi-Chi Li Wei |
| Author_FL_xml | – sequence: 1 fullname: Chen Mu – sequence: 2 fullname: Wang Zhi-Quan – sequence: 3 fullname: Wang Qun-Shan – sequence: 4 fullname: Sun Jian – sequence: 5 fullname: Zhang Peng-Pai – sequence: 6 fullname: Feng Xiang-Fei – sequence: 7 fullname: Li Wei – sequence: 8 fullname: Yu Ying – sequence: 9 fullname: Liu Bo – sequence: 10 fullname: Mo Bin-Feng – sequence: 11 fullname: Zhang Rui – sequence: 12 fullname: Yang Mei – sequence: 13 fullname: Gong Chang-Qi – sequence: 14 fullname: Zhao Ming-Zhe – sequence: 15 fullname: Yu Yi-Chi – sequence: 16 fullname: Zhao Yan – sequence: 17 fullname: Lu Qiu-Fen – sequence: 18 fullname: Li Yi-Gang |
| Author_xml | – sequence: 1 givenname: Mu surname: Chen fullname: Chen, Mu organization: Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China – sequence: 2 givenname: Zhi-Quan surname: Wang fullname: Wang, Zhi-Quan – sequence: 3 givenname: Qun-Shan surname: Wang fullname: Wang, Qun-Shan – sequence: 4 givenname: Jian surname: Sun fullname: Sun, Jian – sequence: 5 givenname: Peng-Pai surname: Zhang fullname: Zhang, Peng-Pai – sequence: 6 givenname: Xiang-Fei surname: Feng fullname: Feng, Xiang-Fei – sequence: 7 givenname: Wei surname: Li fullname: Li, Wei – sequence: 8 givenname: Ying surname: Yu fullname: Yu, Ying – sequence: 9 givenname: Bo surname: Liu fullname: Liu, Bo – sequence: 10 givenname: Bin-Feng surname: Mo fullname: Mo, Bin-Feng – sequence: 11 givenname: Rui surname: Zhang fullname: Zhang, Rui – sequence: 12 givenname: Mei surname: Yang fullname: Yang, Mei – sequence: 13 givenname: Chang-Qi surname: Gong fullname: Gong, Chang-Qi – sequence: 14 givenname: Ming-Zhe surname: Zhao fullname: Zhao, Ming-Zhe – sequence: 15 givenname: Yi-Chi surname: Yu fullname: Yu, Yi-Chi – sequence: 16 givenname: Yan surname: Zhao fullname: Zhao, Yan – sequence: 17 givenname: Qiu-Fen surname: Lu fullname: Lu, Qiu-Fen – sequence: 18 givenname: Yi-Gang surname: Li fullname: Li, Yi-Gang |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32433041$$D View this record in MEDLINE/PubMed |
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| Keywords | One-stop procedure Stroke Atrial fibrillation Left atrial appendage closure Catheter ablation WATCHMAN |
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| References | Holmes (R20-20230816) 2009; 374 Casu (R23-20230816) 2017; 19 Blomstrom-Lundqvist (R3-20230816) 2019; 321 Swaans (R16-20230816) 2012; 1 Price (R21-20230816) 2014; 3 Holmes (R18-20230816) 2014; 64 Phillips (R17-20230816) 2018; 20 Kelly (R30-20230816) 2017; 17 Graves (R8-20230816) 2018; 20 Reddy (R19-20230816) 2014; 312 Di Biase (R22-20230816) 2014; 129 Reddy (R10-20230816) 2013; 61 Phan (R26-20230816) 2019; 26 Boersma (R14-20230816) 2019; 12 Cosedis Nielsen (R24-20230816) 2012; 367 Piccini (R11-20230816) 2017; 38 Li (R27-20230816) 2019; 30 Calkins (R5-20230816) 2017; 14 Joza (R7-20230816) 2018; 29 Jeevanantham (R25-20230816) 2010; 105 Turagam (R12-20230816) 2018; 72 Packer (R2-20230816) 2019; 321 Guo (R1-20230816) 2017; 130 O’Brien (R9-20230816) 2014; 167 Du (R28-20230816) 2019; 118 Di Biase (R29-20230816) 2012; 60 Mark (R4-20230816) 2019; 321 Barra (R6-20230816) 2018; 266 Huang (R13-20230816) 2017; 130 Reddy (R15-20230816) 2017; 70 |
| References_xml | – volume: 1 start-page: e002212 year: 2012 ident: R16-20230816 article-title: Ablation for atrial fibrillation in combination with left atrial appendage closure: first results of a feasibility study publication-title: J Am Heart Assoc doi: 10.1161/JAHA.112.002212 – volume: 367 start-page: 1587 year: 2012 ident: R24-20230816 article-title: Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation publication-title: N Engl J Med doi: 10.1056/NEJMoa1113566 – volume: 14 start-page: e275 year: 2017 ident: R5-20230816 article-title: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation publication-title: Heart Rhythm doi: 10.1016/j.hrthm.2017.05.012 – volume: 38 start-page: 869 year: 2017 ident: R11-20230816 article-title: Left atrial appendage occlusion: rationale, evidence, devices, and patient selection publication-title: Eur Heart J – volume: 321 start-page: 1261 year: 2019 ident: 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| Snippet | Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with... BackgroundCatheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in... Background::Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in... Background. Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in... |
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| SubjectTerms | Ablation Atrial Appendage - surgery Atrial Fibrillation - surgery Blood clots Cardiac arrhythmia Catheter Ablation Catheters Contraindications Demographics Electrocardiography Embolisms Feasibility Studies Humans Magnetic resonance imaging Male Medical imaging Original Patients Sinuses Stroke Treatment Outcome Veins & arteries |
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| Title | One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure |
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