RECENT FINDINGS Several r and omized control trials and systematic review s demonstrate the safety and efficacy of atrial fibrillation ablation in patients with heart failure and left ventricular systolic dysfunction .
In multiple trials , these patients have shown clinical benefit from atrial fibrillation ablation including improved left ventricular systolic function , quality of life , and clinical heart failure symptoms .
SUMMARY Atrial fibrillation ablation in heart failure patients remains well tolerated with an overall efficacy comparable to atrial fibrillation ablation in patients without heart failure .
There is consistent evidence for the clinical benefit of atrial fibrillation ablation in heart failure patients with left ventricular systolic dysfunction and limited evidence for atrial fibrillation ablation in heart failure patients with preserved ejection fraction .
Currently , there is insufficient data regarding the safety and efficacy of left atrial appendage closure devices in heart failure patients
PURPOSE OF REVIEW Patients with atrial fibrillation and heart failure experience an increased morbidity and mortality from the hemodynamic consequences of atrial fibrillation and an increased stroke risk .
Consequently , there has been increased attention to procedural alternatives to pharmacologic rhythm control and anticoagulation for stroke prevention .
This review aims to evaluate the evidence for atrial fibrillation ablation and left atrial appendage closure in heart failure patients .
Multicenter study on acute and long-term safety and efficacy of percutaneous left atrial appendage closure using an epicardial suture snaring device.
BACKGROUND Pericardial suture ligation of the left atrial appendage ( LAA ) may be an alternative to endoluminal devices for stroke prevention in patients with atrial fibrillation , but multicenter safety and efficacy data in high-risk patients with contraindications to oral anticoagulation are lacking . OBJECTIVE The purpose of this study was to report the outcomes of consecutive cases of pericardial suture ligation of the LAA in high-risk patients performed at 4 centers . METHODS The cohort included 41 consecutive patients who underwent LAA closure with the LARIAT system .  Epicardial and transeptal access was obtained , and the epicardial snare was advanced over an endo-epicardial magnetic-tipped guidewire to close the LAA . Transesophageal echocardiography was used to confirm LAA exclusion . RESULTS Mean age was 75 ± 10 years , mean CHADS2 score was 3.0 ± 1.3 , and mean HAS-BLED score was 4.4 ± 1.4 . These patients accumulated 24.6 person-years of follow-up . Acute LAA closure was achieved in 38 patients ( 93 % ) . Transesophageal echocardiography or computerized tomographic angiography performed up to 3.3 ± 0.8 months after the procedure demonstrated LAA leakage in 24 % of patients . One patient ( 2 % ) had a transient ischemic attack , and 8 ( 20 % ) developed pericardial effusions requiring pericardiocentesis . Four cases ( 9 % ) were complicated by perforation of the LAA , with 2 of these patients requiring open surgical correction . CONCLUSION This multicenter experience revealed that pericardial suture ligation with the LARIAT system is technically feasible and acutely efficacious . However , additional improvements are required to minimize the rate of pericardial complications . A r and omized study is warranted to accurately define the long-term efficacy and safety profile of percutaneous epicardial suture ligation
RECENT FINDINGS Several r and omized control trials and systematic review s demonstrate the safety and efficacy of atrial fibrillation ablation in patients with heart failure and left ventricular systolic dysfunction .
In multiple trials , these patients have shown clinical benefit from atrial fibrillation ablation including improved left ventricular systolic function , quality of life , and clinical heart failure symptoms .
SUMMARY Atrial fibrillation ablation in heart failure patients remains well tolerated with an overall efficacy comparable to atrial fibrillation ablation in patients without heart failure .
There is consistent evidence for the clinical benefit of atrial fibrillation ablation in heart failure patients with left ventricular systolic dysfunction and limited evidence for atrial fibrillation ablation in heart failure patients with preserved ejection fraction .
Currently , there is insufficient data regarding the safety and efficacy of left atrial appendage closure devices in heart failure patients
PURPOSE OF REVIEW Patients with atrial fibrillation and heart failure experience an increased morbidity and mortality from the hemodynamic consequences of atrial fibrillation and an increased stroke risk .
Consequently , there has been increased attention to procedural alternatives to pharmacologic rhythm control and anticoagulation for stroke prevention .
This review aims to evaluate the evidence for atrial fibrillation ablation and left atrial appendage closure in heart failure patients .