title: Impact of left atrial appendage exclusion using an epicardial ligation system (LARIAT) on atrial fibrillation burden in patients with cardiac implantable electronic devices.
abstract: BACKGROUND
  The left atrial appendage (LAA) is a well-known source of atrial arrhythmia and atrial fibrillation (AF).
  
  
  OBJECTIVE
  The purpose of this study was to determine whether LAA exclusion using the LARIAT device would decrease AF burden.
  
  
  METHODS
  A total of 50 patients with AF and cardiac implantable electronic devices who underwent successful LAA exclusion were enrolled in this prospective observational study. AF burden before LAA exclusion (baseline) and 3 and 12 months after exclusion was assessed by device interrogation.
  
  
  RESULTS
  AF burden at 3-month follow-up (42% ± 34%) was significantly lower compared to baseline (76% ± 33%, P < .0001). The reduction in AF burden was sustained at 12 months (59% ± 26%, P < .001). Subgroup analysis revealed that AF burden at 3-month follow-up was similarly reduced in both paroxysmal AF (n = 19) and nonparoxysmal AF (n = 31). However, there was no reduction in AF burden in patients with paroxysmal AF at 12 months. AF burden in patients with known AF triggers in the LAA (n = 9) was significantly reduced at 3 months (52% ± 35%) and 12 months (42% ± 19%) compared to respective baseline (84 ± 31%, P < .0001).
  
  
  CONCLUSIONS
  LAA exclusion appears to reduce AF burden. The presence of AF triggers in the LAA appears to be the strongest predictor of AF reduction. The study underscores the role of the LAA in arrhythmogenesis for AF and highlights the complementary role of LAA exclusion in restoration of normal sinus rhythm.
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Afzal
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Earnest
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.affiliation: John Paul II, Krakow, Poland.
authors.forename: Krystof
authors.initials: K
authors.lastname: Bartus
authors.affiliation: Texas Heart Institute, St. Lukes Hospital, Houston, Texas.
authors.forename: Abdi
authors.initials: A
authors.lastname: Rasekh
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Fred
authors.initials: F
authors.lastname: Han
authors.affiliation: University of San Francisco, San Francisco, California.
authors.forename: Nitish
authors.initials: N
authors.lastname: Badhwar
authors.affiliation: Texas Heart Institute, St. Lukes Hospital, Houston, Texas; University of Texas, Houston, Texas.
authors.forename: Jie
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas.
authors.forename: Luigi
authors.initials: L
authors.lastname: Dibiase
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Ellis
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: University of San Francisco, San Francisco, California.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Lee
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, Kansas. Electronic address: dlakkireddy@mac.md.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000628:therapy*; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D011446:Prospective Studies; D013537:Sutures; D016896:Treatment Outcome
keywords: Atrial fibrillation; Left atrial appendage; Pericarditis; Suture exclusion