title: Unexpectedly High Incidence of Stroke and Left Atrial Appendage Thrombus Formation After Electrical Isolation of the Left Atrial Appendage for the Treatment of Atrial Tachyarrhythmias.
abstract: BACKGROUND
  Electric left atrial appendage (LAA) isolation (LAAI) may occur during catheter ablation of atrial tachyarrhythmias. Data regarding the risk of thromboembolic events and stroke after LAAI are sparse. This study evaluated the incidence of LAA thrombus formation and thromboembolic events after LAAI.
  
  
  RESULTS
  Fifty patients had LAAI (age=71 years; female=56%; CHA2DS2-VASc score before ablation =3 [2;3]). LAAI patients were compared with matched patients with comparable baseline characteristics who underwent atrial fibrillation ablation without LAAI (n=50). Ablation strategies in the LAAI group included pulmonary vein isolation in 50 (100%), left atrial isthmus line in 47 (94%), anterior line in 45 (90%), complex atrial fractionated potentials in 24 (48%), and roofline in 14 (28%) patients. Transesophageal echocardiography was performed during follow-up in 47/50 (94%) patients in the LAAI group and in all patients of the control group. Oral anticoagulation (OAC) independent of CHA2DS2-VASc score was strongly recommended in all patients. During a median follow-up of 6.5 (4-12) months, stroke occurred in 2 patients on OAC and transient ischemic attack in one without OAC in the LAAI group. In the remaining 47 patients, LAA thrombus was identified on transesophageal echocardiography in 10 (21%) patients (OAC=9; no OAC=1). In the control group, no LAA thrombus was detected and no stroke occurred (P<0.001). Stable sinus rhythm was maintained in 32 patients (64%) of the LAAI group after a median follow-up of 6.5 months (4-12), including 17/32 patients on antiarrhythmic drugs.
  
  
  CONCLUSIONS
  After LAAI, an unexpectedly high incidence of LAA thrombus formation and stroke was observed despite OAC therapy.
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.). arillig5@yahoo.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Roland R
authors.initials: RR
authors.lastname: Tilz
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Tina
authors.initials: T
authors.lastname: Lin
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Fink
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Christian-H
authors.initials: CH
authors.lastname: Heeger
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Anita
authors.initials: A
authors.lastname: Arya
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Shibu
authors.initials: S
authors.lastname: Mathew
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Hisaki
authors.initials: H
authors.lastname: Makimoto
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: From the Department of Cardiology, Asklepios Klinik St Georg (A.R., R.R.T., T.L., T.F., C.-H.H., A.A., A.M., S.M., E.W., H.M., K.-H.K., F.O.) and Asklepios proresearch, Hamburg, Germany (P.W.).
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005260:Female; D005858:Germany / Q000453:epidemiology; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*
keywords: appendage isolation; atrial fibrillation; catheter ablation; left atrial appendage; stroke; thrombus