Key result
AF ablation during LAAO is linked to ~58% more in-hospital major adverse events despite similar leak.
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Why the study?
The safety and effectiveness of concomitant catheter ablation at the time of left atrial appendage occlusion were not well-characterized.
Does concomitant catheter ablation at the time of left atrial appendage occlusion affect safety and effectiveness compared to LAAO alone in patients with atrial fibrillation?
Observational (n=96,968)
Does concomitant catheter ablation at the time of left atrial appendage occlusion affect safety and effectiveness compared to LAAO alone in patients with atrial fibrillation?
Concomitant AF ablation with LAAO is associated with higher peri-procedural bleeding and effusion risks but lower 1-year mortality and stroke, likely reflecting a younger, healthier patient population selected for the combined procedure.
Concomitant ablation may raise peri-procedural risk during LAAO; leaves open net benefit in selected patients.
BACKGROUND The safety and effectiveness of concomitant catheter ablation at the time of left atrial appendage occlusion (LAAO) are not well-characterized. OBJECTIVE Describe the safety and effectiveness of LAAO during concomitant ablation of AF with LAAO performed as a stand-alone procedure. METHODS Patients from SURPASS who underwent concomitant ablation and LAAO were compared with patients who underwent LAAO alone. The primary effectiveness endpoint was complete seal of the LAA and the primary safety endpoint was the occurrence of major adverse events at 45 days. RESULTS Among 96,968 patients, 1.9% (n=1844) underwent concomitant ablation; these patients were younger (median 73 [Q1,Q3:68,78] vs 76 [72,82] years), had lower CHA2DS2-VASc scores (4 [3,5] vs 5 [4,6]), prior clinically relevant bleeding (32.4 vs 56.6%), or fall risk (30.2 vs 42.2%). The most common discharge drug therapy in the concomitant AF ablation group was DOAC plus aspirin (56.2%) followed by DOAC alone (30.0%). Immediately post-implant, patients undergoing concomitant ablation had lower rates of any residual leak (1.6 vs 3.7%, p<0.001); no difference was seen at 45 days (15.7 vs 16.9%, p=0.29). In-hospital major adverse events were more frequent in those undergoing LAAO with concomitant ablation versus LAAO without ablation (1.9% vs 1.2%, p=0.0111). In-hospital major bleeding (1.6% vs 1.0%, p=0.0073) and pericardial effusion requiring intervention (0.8% vs 0.4%, p=0.0108) were more frequent with combined LAAO and AF ablation. At 1 year post-procedure, the composite of all-cause mortality, stroke, or systemic embolism was less frequent in those undergoing LAAO with concomitant ablation (5.2% vs 9.3%, p<0.0001). CONCLUSION Patients undergoing concomitant AF ablation at the time of LAAO are younger and have fewer comorbidities. There was no clinically important difference in LAA seal peri-device leaks with concomitant LAAO, however, there was a higher rate of major bleeding and pericardial effusion requiring intervention.
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Piccini et al. (2026) conducted an observational in Atrial fibrillation (n=96,968). Concomitant catheter ablation and LAAO vs. LAAO alone was evaluated on In-hospital major adverse events (p=0.0111). Concomitant AF ablation during LAAO was associated with higher in-hospital major adverse events (1.9% vs 1.2%, p=0.0111) but similar residual leak at 45 days (15.7% vs 16.9%, p=0.29).
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