A left atrial appendage closure combined procedure review: Past, present, and future perspectives

J Cardiovasc Electrophysiol. 2019 Aug;30(8):1345-1351. doi: 10.1111/jce.13957. Epub 2019 May 15.

Abstract

Background and objective: Atrial fibrillation (AF) represents the most common cardiac arrhythmia worldwide; it poses a great burden in terms of quality of life reduction and yearly stroke risk. Left atrial appendage closure (LAAC) is a stroke prevention strategy that has been proven a viable alternative to antithrombotic regimens in nonvalvular AF patients. LAAC can be performed as a standalone procedure or alongside a concomitant AF transcatheter ablation, in a procedure known as "Combined procedure". Aim of this study is to summarize the scientific evidence backing this combined strategy.

Methods: We reviewed the whole Medline indexed combined procedure literature, to summarize all the combined procedure study data.

Results: Nine published studies regarding combined procedure were found. Data, aims, and scientific rationales were reported and commented.

Conclusion: LAA combined procedure appears to be a safe and effective procedure; a careful patient selection is necessary to maximize its benefit.

Keywords: atrial fibrillation; catheter ablation; combined ablation; left atrial appendage; left atrial appendage closure; review; stroke prevention.

Publication types

  • Review

MeSH terms

  • Action Potentials
  • Atrial Appendage / physiopathology*
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy*
  • Atrial Function, Left*
  • Cardiac Catheterization* / adverse effects
  • Cardiac Catheterization* / instrumentation
  • Cardiac Catheterization* / trends
  • Catheter Ablation* / adverse effects
  • Catheter Ablation* / instrumentation
  • Catheter Ablation* / trends
  • Clinical Decision-Making
  • Combined Modality Therapy
  • Cryosurgery* / adverse effects
  • Cryosurgery* / instrumentation
  • Cryosurgery* / trends
  • Diffusion of Innovation
  • Forecasting
  • Heart Rate*
  • Humans
  • Patient Selection
  • Risk Assessment
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / physiopathology
  • Stroke / prevention & control*
  • Time Factors
  • Treatment Outcome