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Effect of Left Atrial Appendage Excision on Procedure Outcome in Patients with Persistent Atrial Fibrillation Undergoing Surgical Ablation.

Research paper by Alexander A Romanov, Evgeny E Pokushalov, Dmitry D Elesin, Alexander A Bogachev-Prokophiev, Dmitry D Ponomarev, Denis D Losik, Sevda S Bayramova, Artem A Strelnikov, Vitaliy V Shabanov, Oleg O Pidanov, Evgeny E Kropotkin, Eduard E Ivanickii, Alexander A Karaskov, Jonathan S JS Steinberg

Indexed on: 18 May '16Published on: 18 May '16Published in: Heart Rhythm



Abstract

Catheter ablation is less successful for persistent atrial fibrillation (PersAF) than for paroxysmal atrial fibrillation. Some studies suggest that left atrial appendage (LAA) isolation in addition to pulmonary vein isolation (PVI) is required to maximize benefits for PersAF after ablation.To compare the efficacy and safety of two surgical ablation approaches for PersAF via video-assisted thoracoscopic: PVI + box lesion and PVI + box lesion + LAA excision.We randomly assigned 176 patients with PersAF to video-assisted thoracoscopic surgical ablation with PVI + box lesion (88 patients) or PVI + box lesion + LAA excision (88 patients). The primary endpoint was freedom from any documented atrial arrhythmia lasting longer than 30 seconds after a single ablation procedure without antiarrhythmic drug (AAD).After 18 months of follow-up, 61 (70.9%) out of 86 patients assigned to PVI + box lesion were free from recurrent AF, as compared with 64 (73.6%) out of 87 patients assigned to PVI + box lesion + LAA excision after a single ablation procedure without AAD (P = 0.73). Freedom from any atrial arrhythmia after single procedure with or without AAD was also nonsignificant: 70.9% vs 74.7%, respectively. There were no significant differences in adverse events between groups, including death, transient ischemic attack, stroke, pneumothorax and hydrothorax.Among patients with persAF, we found no reduction in the rate of recurrent AF when LAA excision was performed in addition to PVI and box lesion during surgical ablation.URL: http://www.clinicaltrials.gov. Unique identifier: NCT02562391.

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