Abstract 17328: Ablation of the Left Atrial Appendage ”Stump” to Cure Post Surgical Maze Patients
Introduction: The left atrial appendage (LAA) is a possible site of initiation of atrial fibrillation and is considered the major source of thromboembolic stroke in patients with atrial fibrillation. Often and especially in patients with persitent or long-standing persistent atrial fibrillation undergoing surgical Maze, the LAA is excised or ligated with the creation of a LAA “stump”. The aim of our study was to report the prevalence of AF firing from the ‘stump” and the safety and feasibility of LAA ‘stump” ablation.
Methods: 14 patients undergoing redo ablation for atrial fibrillation after a failed surgical ablation were enrolled in this study. Ablation of the LAA “stump” was performed utilizing the ICE catheter as guidance and positioning the circular catheter over the “stump”. All patients were followed up for at least one year with holter monitoring and event recorders.
Results: Out of the 14 patients with previous LAA amputation referred to our Institution, 11 demonstrated firing from LAA “stump” (79%). The mean RF time for LAA stump ablation was was 29 ± 7 minutes. After LAA ablation, one patient (9%) experienced hemothorax. The patients did not require surgery. None of the patients had phrenic nerve injury. All patients were discharged after a median hospitalization of 1 day. At 12 months follow-up 10 of the 11 patients with LAA “stump” ablated, were in sinus rhythm on or off AADs.
Conclusions: Ablation of the LAA “stump” may be necessary during repeat procedure following surgical ablation of atrial fibrillation to achieve freedom from AF. Ablation of the LAA “stump” appeared to be feasible and relatively safe despite the need for prolonged RF applications.
- © 2010 by American Heart Association, Inc.