Left Atrial Appendage Electrical Isolation and Concomitant Device Occlusion to Treat Persistent Atrial Fibrillation

Catheter ablation has transformed the treatment of atrial fibrillation (AF); however, the rhythm outcomes in treating persistent AF are variable, often requiring multiple procedures to maintain long-term freedom from atrial arrhythmias. Electric isolation of the pulmonary veins (PVs) is central to catheter ablation strategies; however, focal sources and other arrhythmic substrates outside the PVs have been found to play a key role in maintaining persistent AF. The left atrial appendage (LAA) has been shown to be a particularly important source of foci perpetuating AF. Consequently, LAA electric isolation may improve freedom from AF. However, ablation within the LAA carries a risk of perforation, whereas ostial electric isolation of the LAA without occlusion carries a risk of thromboembolism. The combination of conventional AF ablation with LAA electric isolation and occlusion within a single procedure may be synergistic in improving the success rate of ablation while also mitigating stroke risk and reducing the bleeding risk of longterm anticoagulation.