Aims Pulmonary veins (PVs) isolation is the cornerstone of atrial fibrillation (AF) ablation and can be achieved either by conventional radiofrequency ablation or by cryoenergy. Left atrial appendage (LAA) closure has been proposed as alternative treatment to vitamin K antagonists (VKA). We aimed to evaluate the feasibility of combining cryoballoon (CB) ablation and LAA occlusion in patients with AF and a high thromboembolic risk or contraindication to antithrombotic therapy. Methods and results Thirty-five patients (28 males, 74 Â± 2 years) underwent CB ablation. Left atrial appendage occlusion was carried out by using two occluder devices (Amplatz Cardiac Plug, ACP, St. Jude Medical, MN, USA, in 25 patients; Watchman, Boston Scientific, MA, USA, in 10 patients). Thirty patients (86%) had previous stroke/TIA episodes, 6 patients (17%) had major bleeding while on VKA therapy, and 7 patients (20%) had inherited bleeding disorders. Over the follow-up (24 Â± 12 months), atrial arrhythmias recurred in 10 (28%) patients. Thirty patients (86%) had complete sealing; 5 patients (14%) showed a residual flow (<5 mm) at first transoesophageal echocardiography (TEE) check, while at 1-year TEE residual flow was detected in 3 patients. In 13 patients (37%), VKA therapy was immediately discontinued. Six patients (17%) received novel oral anticoagulants treatment and then discontinued 3 months thereafter. No device-related complications or clinical thromboembolic events occurred. Conclusion Combined CB ablation and LAA closure using different devices appears to be feasible in patients with non-valvular AF associated with high risk of stroke or contraindication to antithrombotic treatment.
Concomitant cryoballoon ablation and percutaneous closure of left atrial appendage in patients with atrial fibrillation / G. Fassini, S. Conti, M. Moltrasio, A. Maltagliati, F. Tundo, S. Riva, A. Dello Russo, M. Casella, B. Majocchi, M. Zucchetti, E. Russo, V. Marino, M. Pepi, C. Tondo. - In: EUROPACE. - ISSN 1099-5129. - 18:11(2016 Nov), pp. 1705-1710.
|Titolo:||Concomitant cryoballoon ablation and percutaneous closure of left atrial appendage in patients with atrial fibrillation|
|Parole Chiave:||left atrial appendage closure; aged; anticoagulants; atrial appendage; atrial fibrillation; catheter ablation; echocardiography, three-dimensional; female; follow-up studies; hemorrhage; humans; male; prospective studies; pulmonary veins; recurrence; stroke; treatment outcome; United States; septal occluder device; cardiology and cardiovascular medicine; physiology (medical)|
|Settore Scientifico Disciplinare:||Settore MED/11 - Malattie dell'Apparato Cardiovascolare|
|Data di pubblicazione:||nov-2016|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1093/europace/euw007|
|Appare nelle tipologie:||01 - Articolo su periodico|