title: Ablation of Atrial Fibrillation in Combination with Left Atrial Appendage Occlusion in A Single Procedure. Rationale and Technique.
abstract: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and is associated with a fivefold increase in the risk of ischemic stroke and systemic embolism. Left atrial appendage (LAA) is the source of thrombi in up to 90% of patients with nonvalvular atrial fibrillation (AF). Although thromboembolic prophylaxis by means of oral anticoagulants (OAC) has been shown to be very effective (OAC), they also confer an inevitably risk of serious bleeding. Catheter ablation (CA) is an effective treatment for symptomatic AF but its role in stroke prevention remains unproved. Recently, LAA percutaneous occlusion has been demonstrated to be equivalent to OACs in reducing thromboembolic events. The aim of this review is to describe the rationale, feasibility, outcomes and technique of a combined procedure of AFCA and percutaneous LAAO, two percutaneous interventions that share some procedural issues and technical requirements, in patients with symptomatic drug-refractory AF, high risk of stroke, and contraindications to OACs.
authors.affiliation: Clinica Universidad de Navarra. Pamplona, Spain.
authors.forename: Ignacio García
authors.initials: IG
authors.lastname: Bolao
authors.affiliation: Clinica Universidad de Navarra. Pamplona, Spain.
authors.forename: Naiara
authors.initials: N
authors.lastname: Calvo
authors.affiliation: Clinica Universidad de Navarra. Pamplona, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Macias
authors.affiliation: Clinica Universidad de Navarra. Pamplona, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Barba
authors.affiliation: Clinica Universidad de Navarra. Pamplona, Spain.
authors.forename: Nahikari
authors.initials: N
authors.lastname: Salterain
authors.affiliation: Clinica Universidad de Navarra. Pamplona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ramos
authors.affiliation: Clinica Universidad de Navarra. Pamplona, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ballesteros
authors.affiliation: Clinica Universidad de Navarra. Pamplona, Spain.
authors.forename: Renzo
authors.initials: R
authors.lastname: Neglia
keywords: Atrial Fibrillation Ablation; Left Atrial Appendage Closure; Thromboembolism