Thoracoscopic Left Atrial Appendage Excision Plus Ablation for Atrial Fibrillation to Prevent Stroke

Ni, Buqing, Wang, Zidun, Gu, Weidong, Li, Mingfang, Chen, Minglong, Lip, Gregory YH ORCID: 0000-0002-7566-1626 and Shao, Yongfeng
(2020) Thoracoscopic Left Atrial Appendage Excision Plus Ablation for Atrial Fibrillation to Prevent Stroke. Seminars in Thoracic and Cardiovascular Surgery, 33 (1). pp. 61-67.

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Atrial fibrillation (AF) patients with a previous stroke are often at a high risk of recurrent stroke and bleeding. Anticoagulation therapy in such patients is a challenging dilemma. Thoracoscopic left atrial appendage excision (LAAE) plus AF ablation is an interventional approach offered to some AF patients. We hypothesized that this approach may be suitable as a secondary stroke prevention strategy for these high-risk patients. Between January 2013 and December 2016, a total of 44 patients (26 male; mean age 65.0 ± 9.1 years) with nonvalvular AF and a previous stroke or systemic thromboembolic event were enrolled. The patients underwent thoracoscopic LAAE plus AF ablation by experienced operators and were followed up for 2 years (at 1, 3, 6, 9, and 12 months postoperatively and every 6 months thereafter). Thromboembolic and major bleeding events were recorded. Cerebral computed tomography or magnetic resonance imaging and 7-day Holter monitoring were performed annually. Mean CHA2DS2-VASc and HAS-BLED scores were 4.2 ± 1.2 and 3.3 ± 0.7, respectively. All patients discontinued oral anticoagulation therapy after the surgical intervention. One patient suffered a periprocedural transient ischemic attack, and another was diagnosed with a new ischemic stroke at 491 days after surgery. The annual rate of total thromboembolism was 2.05%. No deaths or major bleeding events were observed postoperatively. The rate of successful AF ablation with no AF recurrence was 76.3%. Transthoracoscopic LAAE plus AF ablation may be a promising approach for this high-risk population. Thromboembolism event in this secondary prevention cohort was low, even without oral anticoagulation treatment.

Item Type: Article
Uncontrolled Keywords: Atrial fibrillation, Stroke, Thorascopy, Left atrial appendage excision, Ablation
Depositing User: Symplectic Admin
Date Deposited: 07 Sep 2020 10:28
Last Modified: 18 Jan 2023 23:34
DOI: 10.1053/j.semtcvs.2020.06.041
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