Electrical isolation of the left atrial appendage in East Asian patients with atrial fibrillation

Background

The left atrial appendage (LAA) is a source of non–pulmonary vein triggers in patients with atrial fibrillation (AF). Electrical isolation of the LAA (EILAA) improves rhythm outcome with an inherent risk of embolism unless lifelong anticoagulation is continued. However, evidence of the efficacy and safety of EILAA in the East Asian population remains lacking.

Objective

The purpose of this study was to evaluate the efficacy and safety in East Asian patients who underwent EILAA.

Methods

Using the data from a single center, we identified patients who underwent EILAA for AF between January 2009 and August 2023. Clinical and procedural data were analyzed.

Results

We included a total of 41 patients who underwent EILAA. EILAA was unsuccessful in 2 patients. The median duration of AF was 5.0 years (interquartile range 4.0–10.0 years). Twenty-five patients (65.8%) underwent more than 1 previous ablation for AF before the index procedure. The mean CHA₂DS₂-VASc score was 2.8 ± 1.6. The mean left atrial dimension was 50.6 ± 8.7 mm. The 1-year recurrence rate of atrial arrhythmia after EILAA was 42.0% (21 patients during follow-up). Six patients (14.6%) underwent redo ablation, and 5 of them had durable isolation of the LAA. One patient had cardiac tamponade, which was drained with pericardiocentesis. All patients had taken lifelong anticoagulation, and 3 of them had stroke or systemic embolism during the follow-up period.

Conclusion

EILAA could be a safe and effective strategy for patients with long-standing AF with a history of failed ablation, especially with a high CHA₂DS₂-VASc score. Lifelong anticoagulation is mandatory for patients undergoing EILAA.