Atrial fibrillation ablation in patients with known sludge in the left atrial appendage

作者：Hajjiri Mohammed; Bernstein Scott^*; Saric Muhamed; Benenstein Ricardo; Aizer Anthony; Dym Glenn; Fowler Steven; Holmes Douglas; Bernstein Neil; Mascarenhas Mark; Park David; Chinitz Larry

来源：Journal of Interventional Cardiac Electrophysiology, 2014, 40(2): 147-151.

DOI：10.1007/s10840-014-9892-0

• Atrial fibrillation
• Ablation
• Sludge
• Left atrial appendage

Purpose Transesophageal echocardiography (TEE) is routinely used to assess for thrombus in the left atrium (LA) and left atrial appendage (LAA) in patients undergoing atrial fibrillation (AF) ablation. However, little is known about the outcome of AF ablation in patients with documented LAA sludge. We hypothesize that AF ablation can be performed safely in a proportion of patients with sludge in the LAA and may have a significant benefit for these patients.
Methods We performed a retrospective analysis of all patients undergoing AF ablation at New York University Langone Medical Center (NYULMC) from January 1st 2011 to June 30, 2013. Patients with sludge found on their TEE immediately prior to AF ablation were identified and followed for stroke, AF recurrence, procedural complications, major bleeding, or death.
Results Among 1,076 patients who underwent AF ablation, 8 patients (mean age 69+/-13 years; 75 % men) with sludge were identified. Patients with sludge in their LAA had no incidence of early or late occurrence of stroke during mean follow-up of 10 months. One patient had a left groin hematoma, and two patients had atrial tachycardias that needed a repeat ablation. TEE at the time of repeat ablation demonstrated the presence of spontaneous echo contrast (smoke) and resolution of sludge. There were no deaths.
Conclusion In a cohort of eight patients with LAA sludge who underwent AF ablation, no significant thromboembolic events occurred during or after the procedure. AF ablation can be performed safely and may be beneficial in these patients. Larger studies are warranted to better determine the most appropriate management route.

• 出版日期2014-8