title: Concomitant cryoballoon ablation and percutaneous closure of left atrial appendage in patients with atrial fibrillation.
abstract: OBJECTIVE
  Pulmonary veins (PVs) isolation is the cornerstone of atrial fibrillation (AF) ablation and can be achieved either by conventional radiofrequency ablation or by cryoenergy. Left atrial appendage (LAA) closure has been proposed as alternative treatment to vitamin K antagonists (VKA). We aimed to evaluate the feasibility of combining cryoballoon (CB) ablation and LAA occlusion in patients with AF and a high thromboembolic risk or contraindication to antithrombotic therapy.
  
  
  RESULTS
  Thirty-five patients (28 males, 74 ± 2 years) underwent CB ablation. Left atrial appendage occlusion was carried out by using two occluder devices (Amplatz Cardiac Plug, ACP, St. Jude Medical, MN, USA, in 25 patients; Watchman, Boston Scientific, MA, USA, in 10 patients). Thirty patients (86%) had previous stroke/TIA episodes, 6 patients (17%) had major bleeding while on VKA therapy, and 7 patients (20%) had inherited bleeding disorders. Over the follow-up (24 ± 12 months), atrial arrhythmias recurred in 10 (28%) patients. Thirty patients (86%) had complete sealing; 5 patients (14%) showed a residual flow (<5 mm) at first transoesophageal echocardiography (TEE) check, while at 1-year TEE residual flow was detected in 3 patients. In 13 patients (37%), VKA therapy was immediately discontinued. Six patients (17%) received novel oral anticoagulants treatment and then discontinued 3 months thereafter. No device-related complications or clinical thromboembolic events occurred.
  
  
  CONCLUSIONS
  Combined CB ablation and LAA closure using different devices appears to be feasible in patients with non-valvular AF associated with high risk of stroke or contraindication to antithrombotic treatment.
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy gfassini@ccfm.it gaetano.fassini@ccfm.it.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Fassini
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Conti
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Moltrasio
authors.affiliation: Imaging Department, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Maltagliati
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tundo
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Riva
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Majocchi
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Zucchetti
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Russo
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Marino
authors.affiliation: Imaging Department, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
authors.affiliation: Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D014481:United States
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation ablation; Cryoballoon; Left atrial appendage closure; Stroke; Vitamin K antagonists