Comparative study on the efficacy and safety of different left atrial appendage occluders in one-stop atrial fibrillation procedures

Objective To compare the sealing efficacy and safety of three left atrial appendage (LAA) occluders—WATCHMAN, LAmbre, and LACBES—in a one-stop procedure combining catheter ablation (CA) and LAA occlusion (LAAO) for atrial fibrillation (AF). Methods We retrospectively analyzed 231 AF patients undergoing a one-stop procedure, grouped by implanted occluder (WATCHMAN n = 110, LAmbre n = 72, LACBES n = 49). The 6-month peri-device leak (PDL) was compared across devices, and Firth-corrected logistic regression and Cox proportional hazards models were applied for PDL and stroke analyses, respectively, given low event counts. Results Baseline characteristics were comparable across the three groups ( P 0.05). PDL rates were 8.2% (9/110), 6.9% (5/72), and 4.1% (2/49) for the WATCHMAN, LAmbre, and LACBES groups, respectively, with no statistically significant intergroup differences ( P 0.05). Multivariate analysis using Firth correction confirmed that device type was not an independent predictor of PDL, after adjusting for clinical risk profiles. However, a higher CHA 2 DS 2 -VASc score was an independent risk factor, whereas older age was a protective factor. No statistically significant differences in DRT or stroke incidence were observed among the devices during the study's follow-up period and with its limited sample size. However, the statistical power for these rare safety endpoints was low, necessitating larger studies to confirm long-term safety comparisons. Conclusion In the context of the one-stop AF procedure, the WATCHMAN, LAmbre, and LACBES occluders demonstrated comparable effectiveness in achieving LAA closure. A high CHA 2 DS 2 -VASc score and younger age may be risk factors for PDL, warranting closer monitoring in these patient subgroups.