Long-Term Stroke Risk in Patients Undergoing Left Atrial Appendage Ablation With and Without Complete Isolation

Aneesh Dhorepatil; Angela L Lang; Min Lang; Muhammad Butt; Amit Arbune; David Hoffman; Soufian Almahmeed; Ohad Ziv

doi:10.3389/fcvm.2021.762839

Long-Term Stroke Risk in Patients Undergoing Left Atrial Appendage Ablation With and Without Complete Isolation

Front Cardiovasc Med. 2021 Dec 9:8:762839. doi: 10.3389/fcvm.2021.762839. eCollection 2021.

Authors

Aneesh Dhorepatil¹, Angela L Lang², Min Lang³, Muhammad Butt⁴, Amit Arbune⁵, David Hoffman⁶, Soufian Almahmeed⁴, Ohad Ziv⁴

Affiliations

¹ Heart and Vascular Institute, Tulane University, New Orleans, LA, United States.
² Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
³ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
⁴ Department of Cardiovascular Diseases, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, United States.
⁵ Division of Cardiology, Gill Heart Institute, University of Kentucky, Lexington, KY, United States.
⁶ Heart Associates, Mercy Health St. Elizabeth Youngstown Hospital, Youngstown, OH, United States.

Abstract

Background: Catheter ablation (CA) for atrial fibrillation (AF), may require ablation beyond the pulmonary veins. Prior data suggest that additional LA ablation, particularly left atrial appendage (LAA) ablation, may alter atrial function leading to increased risk of ischemic stroke or transient ischemic attack (IS/TIA). We sought to study the long-term risk of IS/TIA in patients receiving ablation at the LAA compared to those receiving PVI alone and those receiving PVI with additional non-LAA locations. Methods: 350 patients who underwent CA for AF from 2008 to 2018 were included in the study. Locations of ablation in LA evaluated were the posterior wall, anterior wall, inferior wall, inter-atrial septum, lateral wall and the left atrial appendage (LAA). Patients undergoing LAA ablation were further divided as complete isolation (LAAi) and without complete isolation (LAAa). Results: Mean follow up of 4.8 years. In entire cohort, risk of IS/TIA was 1.62/100 patient-years (pys). The risk was highest in patients with LAAi (3.81/100 pys), followed by ablation LAAa (3.74/100 pys). Amongst all LA locations, only LAAi (HR 3.32, p = 0.03) and LAAa (HR 3.18, p = 0.02) were statistically significant predictors of IS/TIA after adjusting for OAC (Oral anticoagulant) use and baseline CHA₂DS₂VASc score. Conclusions: During long term follow-up, only ablation at the left atrial appendage with and without complete isolation was independently associated with an increased risk of IS/TIA in patients undergoing CA for AF. Potential strategies to reduce stroke risk, such as LAA closure, should be considered in these patients.

Keywords: atrial fibrillation; catheter ablation–atrial fibrillation; ischemic stroke; left atrial ablation; left atrial appendage.