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Ablation in Patients With Left Atrial Appendage Closure Devices
Study Questions:
Is it safe to perform left atrial (LA) radiofrequency catheter ablation (RFCA) in patients with a previously implanted LA appendage (LAA) closure device?
Methods:
In this retrospective study, eight patients underwent RFCA (pulmonary vein isolation with or without additional LA ablation) for atrial fibrillation (AF) 41-756 days (mean 201 days) after undergoing successful LAA closure with a WATCHMAN or AMPLATZER Cardiac Plug closure device. All patients received an oral anticoagulant (OAC) for ≥3 months post-ablation.
Results:
A transesophageal echocardiogram (TEE) performed a mean of 503 days post-ablation showed no device dislocation or leakage. A device-related thrombus was observed in one patient 113 days post-ablation despite OAC. With ongoing OAC, the thrombus resolved 20 months post-ablation. The AF recurrence rate at a mean follow-up of 18 months was 27%.
Conclusions:
The authors concluded that RFCA after percutaneous LAA closure is feasible, but may be associated with device-related thrombus formation.
Perspective:
In the PROTECT-AF trial, in which the safety and efficacy of the WATCHMAN LAA closure device was evaluated, a device-related thrombus was observed in 4.2% of patients. However, a thrombus was not seen by TEE 1 day preablation in the patient in this study, making it very likely that the thrombus was a result of RFCA. The activated clotting time target during RFCA in this study was ≥250 ms, and perhaps a target of ≥350 ms would lower the risk of thrombus. Also, the thrombus developed on a closure device that had been implanted 63 days earlier, and perhaps there had not yet been complete endothelialization.
Keywords: Arrhythmias, Cardiac, Anticoagulants, Atrial Appendage, Atrial Fibrillation, Catheter Ablation, Echocardiography, Transesophageal, Tachycardia, Supraventricular, Thrombosis
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