The clinical efficacy of left atrial appendage isolation caused by extensive left atrial anterior wall ablation in patients with atrial fibrillation.

Abstract

The left atrial appendage (LAA) can be a source of atrial fibrillation (AF) triggering or a part of reentry. We sought to determine the characteristics and clinical outcomes of patients with LAA potential delay including electrical isolation (LAAEI) following LA anterior wall (LAAW) ablation for AF. LAAW ablation cases were collected from among 846 patients who underwent catheter ablation (CA). A total of 89 patients were enrolled; they were divided into three groups according to the extent of LAA potential injury. The ejection fractions (EFs) of the LAA and LA were measured by means of LA angiograms. The mean age of all patients was 56.2 ± 10.7years (74 males, 83%). In 47 of the 89 patients, an LAA potential delay was identified after LAAW ablation (group 2). LAAEI was seen in 18 patients (group 3). In the remaining 24 patients, there was no LAA potential delay or LAAEI (group 1). The mean EF decreased significantly after CA in group 3 (P < 0.001). At 21-month follow-up, three patients (17%) in group 3 had recurrence compared with 11 (42%) in group 2 and 12 (46%) in group 3 (P = 0.028). In multivariate analysis, diabetes mellitus and LAA potential delay were independent predictors of AF recurrence (P = 0.021, P = 0.008, respectively). Ablation of the LA anterior wall near the insertion of Bachmann's bundle and the neck of the LAA resulting in LAA potential delay or electrical isolation is effective in preventing recurrence of atrial fibrillation.