Abstract 2253: Left Atrial Appendage Function And Clinical Outcome After Electrical Isolation Of Left Atrial Appendage In Patients Undergoing Atrial Fibrillation Ablation
Electrical isolation of left atrial appendage (LAA) can occur during extensive left atrial (LA) ablation for AF. However, the long-term outcome after electrical isolation is unknown. In this study, we evaluated the echocardiographic LAA function and the clinical outcome after electrical isolation of LAA in this patient cohort.18 consecutive pts (8 male, 64±9 years, LA diameter 45±11mm) were included in this study. Before the 1st procedure, there were 4 pts with paroxysmal AF and 14 pts with long-lasting persistent AF. LAA isolation occurred during the 1st ablation procedure in 1 pt, during the 2nd procedure in 5 pts, during the 3d procedure in 7 pts during the 4th procedure in 4 pts and during the 5th procedure in one pt. Isolation of the LAA was identified by dissociation of electrical activity in the LAA from the LA or by electrical silence in the LAA. After ablation, oral anticoagulation was continued with a target INR of 2–3. LAA function was assessed prior to and 3 months after the procedure by TEE Doppler. LAA flow velocity (LAAFV; filling and emptying), LA diameter, spontaneous echo contrast (SEC) and incidence of LAA thrombus were assessed. LA diameter did not change significantly after LAA isolation (44,6±11 vs 44,5±11cm/s). After LAA isolation, LAAFV (filling) was normal (>50cm/s) in 3 pts, impaired (25<50cm/s) in 7 pts and severely impaired (<25cm/s) in 8/18 pts. SEC was shown in 6 out of these 7 pts with severely impaired LAAFV. More importantly, LAA thrombus was identified in the 2 pts with SEC and subtherapeutic INR values (INR values of 1.6 and 1.7 respectively), one pt with stable SR and one with paroxysmal AT. No clinical thromboembolic events were detected. In the 4 pts with SEC and INR value more than 2, no thrombus were found. During a mean follow up of 8±5 months, 13/18 patients (72%) remained in sinus-rhythm after the last procedure. Significant impairment of LAA function has been observed in 15/18 pts (83%) undergoing LAA isolation. Rigorous monitoring of anticoagulation with INR is mandatory even in patients with stable SR.