July 31, 2023Clinical CardiologyOpen Access

Safety and efficacy of ablation for atrial fibrillation in combination with left atrial appendage occlusion in octogenarians

View Full Paper

Ask AI

Bookmark

Why the study?

Catheter ablation combined with left atrial appendage occlusion is feasible for atrial fibrillation, but its role in octogenarians is unclear.

Does catheter ablation combined with left atrial appendage occlusion have comparable efficacy and safety in octogenarians with atrial fibrillation compared to nonoctogenarians?

Structured PICO

Does catheter ablation combined with left atrial appendage occlusion have comparable efficacy and safety in octogenarians with atrial fibrillation compared to nonoctogenarians?

Population

505 patients with atrial fibrillation undergoing catheter ablation and left atrial appendage occlusion in a single procedure, mean age 69.5 ± 7.7 years, 45.5% female.

Intervention

Catheter ablation combined with left atrial appendage occlusion in a single procedure in octogenarians (aged ≥80 years)

Comparator

Catheter ablation combined with left atrial appendage occlusion in a single procedure in nonoctogenarians (aged <80 years)

Outcome

Efficacy endpoints (procedural success rate, AF recurrence rate, and thromboembolic events) and safety endpoints (pericardial effusion/cardiac tamponade, device-related thrombus, all-cause death, and major bleeding)

The combination of catheter ablation and left atrial appendage occlusion in a single procedure is a feasible treatment option for octogenarians with atrial fibrillation, demonstrating comparable efficacy and safety to younger patients.

Implication

Similar recurrence supports feasibility in octogenarians; leaves open randomized confirmation of safety and efficacy.

Abstract

BACKGROUND: Catheter ablation (CA) combined with left atrial appendage occlusion (LAAO) is a feasible approach for atrial fibrillation (AF) patients. Its role in octogenarians with AF is unclear. HYPOTHESIS: In AF patients over 80 years, CA combined with LAAO is a feasible way in restoring sinus rhythm and preventing stroke. METHODS: This is a single-center retrospective study. Patients who underwent CA and LAAO in a single procedure between March 2018 and December 2020 were included. Efficacy endpoints included procedural success rate, AF recurrence rate, and thromboembolic events. Safety endpoints included pericardial effusion/cardiac tamponade, device-related thrombus (DRT), all-cause death, and major bleeding. RESULTS: Five hundred and five patients (mean age 69.5 ± 7.7 years; 230 [45.5%] female) were included, with 46 (9.1%) patients aged ≥80 years old (octogenarian group). Prevalence of paroxysmal AF (25 [54.3%] vs. 207 [45.1%], p < 0.001) and CHA2DS2VASc score (4.1 ± 1.3 vs. 3.1 ± 1.4, p < 0.0001) were higher in octogenarian patients. There were six cases (1.2%) of pericardial effusion (all in nonoctogenarian patients). At 3 months postprocedure, 437 patients underwent TEE/CT. Thirty-two (80%) octogenarian patients and 308 (77.6%) nonoctogenarian patients had no peri-device leak. After a mean follow-up of 26.9 ± 9.1 months, AF was documented in 10 (21.7%) patients in octogenarian group and in 103 (22.4%) patients in nonoctogenarian group (p = 0.99). The annual thromboembolic risk was 2.1% and 0.8% in the octogenarian group and nonoctogenarian group, respectively. Death occurred in 16 nonoctogenarian patients. One major bleeding was recorded in the octogenarian group. CONCLUSIONS: The combination of CA and LAAO in a single procedure is a feasible treatment option in octogenarians with comparable efficacy and safety profile.