Combined Procedure Versus Catheter Ablation Alone for Atrial Fibrillation: Predictors of Long‐Term Arrhythmia Recurrence

Background Early recurrence (ER) of atrial tachyarrhythmia (ATA) has been proven to predict late recurrence (LR) in patients undergoing catheter ablation (CA). However, the long‐term ATA recurrence in patients undergoing combined left atrial appendage closure (LAAC) and CA procedures remains unclear. Methods This study aimed to investigate the long‐term ATA recurrence after the combined procedure. We enrolled patients with atrial fibrillation (AF) who underwent combined procedures from January 2019 to February 2022. A 1:1 propensity score match was used to identify a comparable cohort from the isolated CA (CA‐only) groups. ER and LR were defined as recurrence of ATA during 8 weeks and beyond an 8‐week blanking period after ablation. Results Among the 326 enrolled patients (aged 67.8 ± 8.7 years, 42.9% female, 26.4% paroxysmal AF), the groups were similar regarding the occurrence of ER (LAAC + CA: 25.2% vs. CA‐only: 20.9%, p = 0.357). After a 4‐year follow‐up, the combined group demonstrated a significantly lower ATA‐free rate compared to the CA‐only group (LAAC + CA: 52.1% vs. CA‐only: 63.2%, log‐rank, p = 0.049). Based on a multivariate Cox regression analysis, the risk of LR significantly increased in patients with ER (hazard ratio [HR] = 1.789, 95% confidence interval [CI] = 1.194–2.681, p = 0.005), the combined procedure (HR = 1.559, 95% CI = 1.072–2.268, p = 0.020), and increased left atrial diameter (LAD) (HR = 1.036, 95% CI = 1.002–1.071, p = 0.036). Conclusions ATA recurrence postprocedure is more frequent in the combined procedure than in the CA‐only procedure after the long‐term follow‐up. ER, the combined procedure, and increased LAD are associated with a higher risk of LR.