Background: The results of the effect of left atrial appendage electrical isolation (LAAEI) on long-term procedure outcome in patients with non-paroxysmal atrial fibrillation(AF) has been described.
Objective: We sought to investigate the incremental benefit of LAAEI in patients undergoing CA for persistent AF or long standing persistent AF (LSPAF).
Methods: A systemic review of Medline, Cochrane, and Embase for all the clinical studies in which assessment LAAEI in non-paroxysmal AF patients was performed. Given the high heterogeneity among studies, a random effect model was used.
Results: A total of 930 patients from seven studies were analyzed, [mean age 63±5 years; male:69%]. Persistent AF, LSPAF or both were included. LAAEI was acutely isolated in 93.4 ± 7.2% of the cases. The overall freedom from all-arrhythmia recurrence at 12-month follow up in patients who underwent LAAEI was 75.5% vs. 43.9% in the standard ablation group. A 56% RRR and a 31.6% ARR in primary endpoint when compared with the control group (RR 0.44, 95% CI 0.31-0.64, P <0.0001). The benefit of performing LAAEI was observed by a 44% RRR and a 26% ARR in all arrhythmia recurrence when compared with the control group (RR 0.56, 95% CI 0.46-0.67, P <0.00001). The rate of ischemic stroke in the LAAEI group was 0.4% and in the control group 2.1% at 12 months follow up (RR 0.40, 95% CI 0.12-1.30, P = 0.13). Acute complications rates were identical between groups [LAAEI 5.5%, Control 5.5% (RR 0.99, 95% CI 0.46-2.16, P = 0.99). Pericardial effusion occurred more often in the LAAEI group 2.7% than in the control group 0.8% but this difference was not statistically significant (RR 1.75, 95% CI 0.67-4.58, P = 0.25).
Conclusion: LAAEI in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from ALL atrial arrhythmias in patients with persistent AF and LSPAF without increasing acute procedural complications and without raising the risk of ischemic stroke, regardless of the technique.