Percutaneous ligation of the left atrial appendage results in atrial electrical substrate modification

Faisal F. Syed, Venu Rangu, Charles J Bruce, Susan B. Johnson, Andrew Danielsen, Emily J. Gilles, Dorothy J. Ladewig, Susan B. Mikell, Steven Berhow, Douglas Wahnschaffe, Scott H. Suddendorf, Samuel J Asirvatham, Paul Andrew Friedman

Research output: Contribution to journalArticle

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Abstract

Debulking of electrically active atrial tissue may reduce the mass of fibrillating tissue during atrial fibrillation, eliminate triggers, and promote maintenance of normal sinus rhythm (NSR). We investigated whether left atrial appendage (LAA) ligation results in modification of atrial electrical substrate. Healthy male mongrel dogs (N = 20) underwent percutaneous epicardial LAA ligation. The ligation system grabber recorded LAA local electrograms (EGM) continuously before, during, and after closure. Successful ligation with a preloaded looped suture was confirmed intraprocedurally by LAA Doppler flow cessation on transesophageal echocardiography (TEE) and loss of LAA electrical activity, and after procedure by direct necropsic visualization. P-wave duration on surface electrocardiograms was measured immediately before and after LAA closure. Percent P-wave duration reduction was correlated with preclosure LAA internal dimensions measured by TEE and external dimensions measured on necropsy specimens to investigate associations of LAA geometry with the extent of electrical substrate modification. LAA ligation was successful in all dogs and accompanied by loss of LAA EGM. P-wave duration reduced immediately on ligation (mean 75 ms preligation to 63 ms postligation; mean difference ± standard error, 12 ± 1 ms; P < 0.0001). Percent P-wave reduction was associated with larger LAA longitudinal cross-sectional area (R2 = 0.263, P = 0.04) and smaller external circumference (R2 = 0.687, P = 0.04). All dogs were in sinus rhythm. Percutaneous LAA ligation results in its acute electrical isolation and atrial electrical substrate modification, the degree of which is associated with LAA geometry. These electrical changes raise the possibility that LAA ligation may promote NSR by removing LAA substrate and triggers.

Original languageEnglish (US)
Article number842
Pages (from-to)365-373
Number of pages9
JournalTranslational Research
Volume165
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Atrial Appendage
Ligation
Echocardiography
Substrates
Tissue
Geometry
Electrocardiography
Visualization
Transesophageal Echocardiography
Dogs
Cardiac Electrophysiologic Techniques

Keywords

  • Abbreviations
  • AF
  • atrial fibrillation
  • ECG
  • EGM
  • electrocardiogram
  • electrogram
  • LAA
  • left atrial appendage
  • TEE
  • transeesophageal echocardiography

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, medical
  • Public Health, Environmental and Occupational Health

Cite this

Percutaneous ligation of the left atrial appendage results in atrial electrical substrate modification. / Syed, Faisal F.; Rangu, Venu; Bruce, Charles J; Johnson, Susan B.; Danielsen, Andrew; Gilles, Emily J.; Ladewig, Dorothy J.; Mikell, Susan B.; Berhow, Steven; Wahnschaffe, Douglas; Suddendorf, Scott H.; Asirvatham, Samuel J; Friedman, Paul Andrew.

In: Translational Research, Vol. 165, No. 3, 842, 01.03.2015, p. 365-373.

Research output: Contribution to journalArticle

Syed, FF, Rangu, V, Bruce, CJ, Johnson, SB, Danielsen, A, Gilles, EJ, Ladewig, DJ, Mikell, SB, Berhow, S, Wahnschaffe, D, Suddendorf, SH, Asirvatham, SJ & Friedman, PA 2015, 'Percutaneous ligation of the left atrial appendage results in atrial electrical substrate modification', Translational Research, vol. 165, no. 3, 842, pp. 365-373. https://doi.org/10.1016/j.trsl.2014.10.007
Syed, Faisal F. ; Rangu, Venu ; Bruce, Charles J ; Johnson, Susan B. ; Danielsen, Andrew ; Gilles, Emily J. ; Ladewig, Dorothy J. ; Mikell, Susan B. ; Berhow, Steven ; Wahnschaffe, Douglas ; Suddendorf, Scott H. ; Asirvatham, Samuel J ; Friedman, Paul Andrew. / Percutaneous ligation of the left atrial appendage results in atrial electrical substrate modification. In: Translational Research. 2015 ; Vol. 165, No. 3. pp. 365-373.
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abstract = "Debulking of electrically active atrial tissue may reduce the mass of fibrillating tissue during atrial fibrillation, eliminate triggers, and promote maintenance of normal sinus rhythm (NSR). We investigated whether left atrial appendage (LAA) ligation results in modification of atrial electrical substrate. Healthy male mongrel dogs (N = 20) underwent percutaneous epicardial LAA ligation. The ligation system grabber recorded LAA local electrograms (EGM) continuously before, during, and after closure. Successful ligation with a preloaded looped suture was confirmed intraprocedurally by LAA Doppler flow cessation on transesophageal echocardiography (TEE) and loss of LAA electrical activity, and after procedure by direct necropsic visualization. P-wave duration on surface electrocardiograms was measured immediately before and after LAA closure. Percent P-wave duration reduction was correlated with preclosure LAA internal dimensions measured by TEE and external dimensions measured on necropsy specimens to investigate associations of LAA geometry with the extent of electrical substrate modification. LAA ligation was successful in all dogs and accompanied by loss of LAA EGM. P-wave duration reduced immediately on ligation (mean 75 ms preligation to 63 ms postligation; mean difference ± standard error, 12 ± 1 ms; P < 0.0001). Percent P-wave reduction was associated with larger LAA longitudinal cross-sectional area (R2 = 0.263, P = 0.04) and smaller external circumference (R2 = 0.687, P = 0.04). All dogs were in sinus rhythm. Percutaneous LAA ligation results in its acute electrical isolation and atrial electrical substrate modification, the degree of which is associated with LAA geometry. These electrical changes raise the possibility that LAA ligation may promote NSR by removing LAA substrate and triggers.",
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AU - Danielsen, Andrew

AU - Gilles, Emily J.

AU - Ladewig, Dorothy J.

AU - Mikell, Susan B.

AU - Berhow, Steven

AU - Wahnschaffe, Douglas

AU - Suddendorf, Scott H.

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AU - Friedman, Paul Andrew

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N2 - Debulking of electrically active atrial tissue may reduce the mass of fibrillating tissue during atrial fibrillation, eliminate triggers, and promote maintenance of normal sinus rhythm (NSR). We investigated whether left atrial appendage (LAA) ligation results in modification of atrial electrical substrate. Healthy male mongrel dogs (N = 20) underwent percutaneous epicardial LAA ligation. The ligation system grabber recorded LAA local electrograms (EGM) continuously before, during, and after closure. Successful ligation with a preloaded looped suture was confirmed intraprocedurally by LAA Doppler flow cessation on transesophageal echocardiography (TEE) and loss of LAA electrical activity, and after procedure by direct necropsic visualization. P-wave duration on surface electrocardiograms was measured immediately before and after LAA closure. Percent P-wave duration reduction was correlated with preclosure LAA internal dimensions measured by TEE and external dimensions measured on necropsy specimens to investigate associations of LAA geometry with the extent of electrical substrate modification. LAA ligation was successful in all dogs and accompanied by loss of LAA EGM. P-wave duration reduced immediately on ligation (mean 75 ms preligation to 63 ms postligation; mean difference ± standard error, 12 ± 1 ms; P < 0.0001). Percent P-wave reduction was associated with larger LAA longitudinal cross-sectional area (R2 = 0.263, P = 0.04) and smaller external circumference (R2 = 0.687, P = 0.04). All dogs were in sinus rhythm. Percutaneous LAA ligation results in its acute electrical isolation and atrial electrical substrate modification, the degree of which is associated with LAA geometry. These electrical changes raise the possibility that LAA ligation may promote NSR by removing LAA substrate and triggers.

AB - Debulking of electrically active atrial tissue may reduce the mass of fibrillating tissue during atrial fibrillation, eliminate triggers, and promote maintenance of normal sinus rhythm (NSR). We investigated whether left atrial appendage (LAA) ligation results in modification of atrial electrical substrate. Healthy male mongrel dogs (N = 20) underwent percutaneous epicardial LAA ligation. The ligation system grabber recorded LAA local electrograms (EGM) continuously before, during, and after closure. Successful ligation with a preloaded looped suture was confirmed intraprocedurally by LAA Doppler flow cessation on transesophageal echocardiography (TEE) and loss of LAA electrical activity, and after procedure by direct necropsic visualization. P-wave duration on surface electrocardiograms was measured immediately before and after LAA closure. Percent P-wave duration reduction was correlated with preclosure LAA internal dimensions measured by TEE and external dimensions measured on necropsy specimens to investigate associations of LAA geometry with the extent of electrical substrate modification. LAA ligation was successful in all dogs and accompanied by loss of LAA EGM. P-wave duration reduced immediately on ligation (mean 75 ms preligation to 63 ms postligation; mean difference ± standard error, 12 ± 1 ms; P < 0.0001). Percent P-wave reduction was associated with larger LAA longitudinal cross-sectional area (R2 = 0.263, P = 0.04) and smaller external circumference (R2 = 0.687, P = 0.04). All dogs were in sinus rhythm. Percutaneous LAA ligation results in its acute electrical isolation and atrial electrical substrate modification, the degree of which is associated with LAA geometry. These electrical changes raise the possibility that LAA ligation may promote NSR by removing LAA substrate and triggers.

KW - Abbreviations

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KW - atrial fibrillation

KW - ECG

KW - EGM

KW - electrocardiogram

KW - electrogram

KW - LAA

KW - left atrial appendage

KW - TEE

KW - transeesophageal echocardiography

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