title: Sequential Percutaneous LAA Ligation and Pulmonary Vein Isolation in Patients with Persistent AF: Initial Results of a Feasibility Study.
abstract: BACKGROUND
  Left atrial appendage (LAA) ligation results in LAA electrical isolation and a decrease in atrial fibrillation (AF) burden. This study assessed the feasibility of combined percutaneous LAA ligation and pulmonary vein isolation (PVI) in patients with persistent AF.
  
  
  RESULTS
  A total of 22 patients with persistent AF underwent LAA ligation with the LARIAT device followed by PVI. PVI was confirmed with the demonstration of both entrance and exit block. Patients (n = 10) in sinus rhythm pre- and post-LAA ligation underwent P-wave analysis. Monitoring for AF was performed at 1, 3, and 6 months postablation. LAA ligation was successful in 21 of 22 (95%) patients. The procedure was aborted in one patient due to pericardial adhesions. PVI was performed in 20 of 21 patients. One patient converted to atrial flutter with a controlled ventricular response after LAA ligation and refused subsequent PVI. Demonstration of entrance and exit block was achieved in 19 of 20 patients. At 3 months, 13 of 19 (68.4%) patients were in sinus rhythm. Four patients underwent a second PVI. At 6 months, 15 of 20 (75%) patients were in sinus rhythm. There was a significant decrease in P-wave duration and P-wave dispersion after LAA ligation. Complications with LAA ligation included pericarditis, a delayed pleural effusion, and a late pericardial effusion.
  
  
  CONCLUSIONS
  Staged LAA ligation and PVI is feasible and decreases P-wave dispersion. Randomized studies are needed to assess the efficacy of LAA ligation as adjunctive therapy to PVI for maintaining sinus rhythm in patients with persistent AF.
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California.
authors.forename: Nitish
authors.initials: N
authors.lastname: Badhwar
authors.affiliation: Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California.
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Kawamura
authors.affiliation: University of Utah Health Sciences Center, Salt Lake City, Utah.
authors.forename: Frederick T
authors.initials: FT
authors.lastname: Han
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California.
authors.forename: Sivaraman K
authors.initials: SK
authors.lastname: Iyer
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Moyers
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Dewland
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California.
authors.forename: Chris
authors.initials: C
authors.lastname: Woods
authors.affiliation: Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ferrell
authors.affiliation: Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Jayant
authors.initials: J
authors.lastname: Nath
authors.affiliation: Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Mathew
authors.initials: M
authors.lastname: Earnest
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California.|Cardiovascular Research Institute at the University of California, San Francisco, California.|Institute for Regeneration Medicine at the University of California, San Francisco, California, USA.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D017115:Catheter Ablation; D004452:Echocardiography; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*
keywords: LAA ligation; LARIAT; P-wave analysis; atrial fibrillation; catheter ablation; pulmonary vein isolation