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Performing transcatheter left atrial appendage closure: Techniques and challenges
The left atrial appendage (LAA) has been demonstrated to be the major source of thromboemboli in patients with atrial fibrillation.1 The rationale of LAA closure is based on eliminating LAA continuity with the left atrium (LA), thereby reducing stroke risk. Indeed, left atrial appendage occlusion (LAAO) procedures play an important role in anticoagulation-intolerant patients who are at risk for atrial fibrillation–related stroke. Based on the PROTECT AF (Watchman Left Atrial Appendage System for Embolic PROTECTion in Patients With Atrial Fibrillation)2 and PREVAIL (Prospective Randomized Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation [AF] Versus Long Term Warfarin Therapy)3 studies, the Food and Drug Administration (FDA) approved use of the Watchman (Boston Scientific, Marlborough, MA) device in 2015, with an updated generation of device subsequently ratified in 2020 following the PINNACLE-FLX (Protection Against Embolism for Nonvalvular AF Patients: Investigational Device Evaluation of the Watchman FLX LAA Closure Technology) study.How to perform an epicardial ventricular tachycardia ablation: A contemporary and practical approach
Catheter ablation is increasingly used for the treatment of cardiac arrhythmias. In the 1990s, in order to treat ventricular arrhythmias resulting from chagasic cardiomyopathy, Sosa et al1 developed a technique to enter the pericardium percutaneously in the absence of a pericardial effusion. Since then, “dry” epicardial access has become a regular part of complex catheter ablation. In this review, we concentrate on the technical aspects of performing epicardial ablation for ventricular tachycardia (VT), including the management of potential complications.How to perform left atrial appendage electrical isolation using radiofrequency ablation
Although pulmonary vein (PV) isolation (PVI) has been considered an effective treatment for paroxysmal atrial fibrillation (AF), non-paroxysmal AF is a complex arrhythmia for which no ablation strategy has been demonstrated to be effective and widely accepted. As such, a success rate of ∼55% in these patients with AF (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II [Star AF II trial]) is not acceptable in our opinion and efforts should be made to seek for alternative strategies.
