Incidence of Left Atrial Appendage Triggers in Patients With Atrial Fibrillation Undergoing Catheter Ablation

Mohamed Al Rawahi, Jackson J. Liang, Suraj Kapa, Aung Lin, Yasuhiro Shirai, Ling Kuo, Erica S. Zado, Matthew C. Hyman, Michael P. Riley, Saman Nazarian, Fermin C. Garcia, David Lin, Robert D. Schaller, Jeffery S. Arkles, David S. Frankel, Gregory E. Supple, Ramanan Kumareswaran, David J. Callans, Francis E. Marchlinski, Sanjay Dixit

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: This study sought to investigate incidence of left atrial appendage (LAA) triggers of atrial fibrillation (AF) and/or organized atrial tachycardias (OAT) in patients undergoing AF ablation and to evaluate outcomes after ablation. Background: Although LAA isolation is being increasingly performed during AF ablation, the true incidence of LAA triggers for AF remains unclear. Methods: All patients with LAA triggers of AF and/or OAT during AF ablation from 2001 to 2017 were included. LAA triggers were defined as atrial premature depolarizations from the LAA, which initiated sustained AF and/or OAT. Results: Out of 7,129 patients undergoing AF ablation over 16 years, LAA triggers were observed in 21 (0.3%) subjects (age 60 ± 9 years; 57% males; 52% persistent AF). Twenty (95%) patients were undergoing repeat ablation. The LAA was the only nonpulmonary vein trigger in 3 patients; the remaining 18 patients had both LAA and other nonpulmonary vein triggers. LAA triggers were eliminated in all patients (focal ablation in 19 patients; LAA isolation in 2 patients). Twelve months after ablation, 47.6% remained free from recurrent arrhythmia. After overall follow-up of 5.0 ± 3.6 years (median: 3.7 years; interquartile range: 1.4 to 8.9 years), 38.1% were arrhythmia-free. All 3 patients with triggers limited to the LAA remained free of AF recurrence. One patient undergoing LAA isolation developed LAA thrombus during follow-up. Conclusions: The incidence of true LAA triggers is very low (0.3%). Most patients with LAA triggers have additional nonpulmonary vein triggers, and despite elimination of LAA triggers, long-term arrhythmia recurrence rates remain high. Potential risks of empiric LAA isolation during AF ablation (especially first-time AF ablation) may outweigh benefits.

Original languageEnglish (US)
Pages (from-to)21-30
Number of pages10
JournalJACC: Clinical Electrophysiology
Issue number1
StatePublished - Jan 2020


  • ablation
  • atrial fibrillation
  • left atrial appendage
  • triggers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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