Anatomical and electrical remodeling with incomplete left atrial appendage ligation: Results from the LAALA-AF registry Journal Article

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Authors: Turagam, M.; Atkins, D.; Earnest, M.; Lee, R; Nath, J.; Ferrell, R.; Bartus, K.; Badhwar, N.; Rasekh, A.; Cheng, J.; Di Biase, L.; Natale, A.; Wilber, D; Lakkireddy, D.
Article Title: Anatomical and electrical remodeling with incomplete left atrial appendage ligation: Results from the LAALA-AF registry
Abstract: BACKGROUND: The anatomical, electrical, and clinical impact of incomplete Lariat left atrial appendage ligation remains unclear. METHODS: We studied LAA anatomy pre- and postligation using contrast enhanced-computed tomography (CT) scans in 91 patients with atrial fibrillation (AF) who subsequently underwent catheter ablation (CA). RESULTS: Eleven patients had an incomplete exclusion (12%) with a central leak ranging from 1 to 5 mm. Despite incomplete ligation; the LAA volume were reduced by 67% postprocedurally when compared to preprocedure. In 7 patients with a leak between 1 and 3 mm, there was a 77% reduction in LAA volume beyond the ligation site suggestive of remodeling of the LAA. In 4 patients with larger (4-5 mm) leak the LAA remnants (LAARs) were slightly larger than those with smaller leaks on follow-up CT scan. Three out of the 4 demonstrated LAA electrical activity during CA and underwent isolation of the LAA ostium. Follow-up imaging showed two of these LAARs completely sealed with no communication with the left atrium. There was no significant difference in the AF recurrence rates between the patients who had a leak versus those with complete ligation (4 of 11 [36%] vs. 22 of 80 [27%]; P = 0.6). Oral anticoagulation was discontinued in all patients with small leaks and 2 patients with large leaks that sealed completely upon follow-up imaging. There were no strokes or TIAs at 12 months. CONCLUSION: Despite incomplete LAA ligation by Lariat device there is significant anatomical and electrical remodeling that resulted in reduction in LAA size, volume, and electrical activity.
Journal Title: Journal of cardiovascular electrophysiology
Volume: 28
Issue: 12
ISSN: 1540-8167; 1045-3873
Publisher: Wiley Periodicals, Inc  
Journal Place: United States
Date Published: 2017
Start Page: 1433
End Page: 1442
Language: eng
DOI/URL:

10.1111/jce.13343
Notes: LR: 20171208; CI: (c) 2017; JID: 9010756; OTO: NOTNLM; 2017/06/15 00:00 [received]; 2017/07/25 00:00 [revised]; 2017/08/01 00:00 [accepted]; 2017/09/25 06:00 [pubmed]; 2017/09/25 06:00 [medline]; 2017/09/24 06:00 [entrez]; ppublish