A single-stage procedure combining catheter ablation and left atrial appendage closure significantly increased 45-day peri-device leakage compared to LAAC alone (45.9% vs 4.3%, P < .001).
Cohort (n=107)
Does a one-stop hybrid procedure combining catheter ablation and LAAC increase the risk of peri-device leakage and adverse events compared to LAAC alone in patients with atrial fibrillation?
Combining catheter ablation with LAAC in a single procedure causes left atrial ridge edema, leading to significantly higher rates of peri-device leakage compared to LAAC alone.
Absolute Event Rate: 45.9% vs 4.3%
p-value: p=<.001
INTRODUCTION: Combined catheter ablation (CA) and left atrial appendage closure (LAAC) have proven to be a feasible and safe strategy in treating patients with nonvalvular atrial fibrillation (AF). However, the interactions between CA and LAAC have not been systematically explored. We analyzed the impact of CA on long-term outcomes of LAAC in patients with AF treated with the hybrid procedure. METHODS: A total of 107 consecutive patients with AF who underwent LAAC were divided into two groups: group A (n = 61) included patients who underwent CA followed by LAAC during the same procedure and group B (n = 46) included patients who underwent LAAC only. All patients underwent systematic transesophageal echocardiography (TEE) follow-up. RESULTS: In group A, CA resulted in severe edema of the left atrial ridge (LAR), which manifested as an increase in LAR thickness from 4.6 ± 0.4 mm before CA to 6.8 ± 0.6 mm (P < .01) after CA. TEE at 45 days showed that the incidence of peri-device leakage was significantly higher in group A than in group B (45.9% vs 4.3%, P < .001). At the 12-month follow-up, the peri-device leakage rate remained higher in group A than in group B (14.8% vs 2.2%, P < .01). Three (4.9%) patients in group A experienced transient ischemia attacks; no events were reported in group B during the 1-year follow-up. CONCLUSION: Edema of LAR with the single-stage procedure that consists of CA followed by LAAC could result in increased peri-device leakage and decreased compression rate over time, which may be also associated with elevated risk profiles when compared with an LAAC-only procedure.
Li et al. (Thu,) conducted a cohort in Nonvalvular atrial fibrillation (n=107). Combined catheter ablation and LAAC vs. LAAC only was evaluated on Peri-device leakage at 45 days (p=<.001). A single-stage procedure combining catheter ablation and left atrial appendage closure significantly increased 45-day peri-device leakage compared to LAAC alone (45.9% vs 4.3%, P < .001).