Key result
LAA electrical isolation linked to ~31% lower odds of LAA patency vs standard ablation.
Why the study?
LAA patency after catheter ablation and LAAC determines postprocedure stroke, but the effect of LAA electrical isolation on LAA patency remains unknown.
Does left atrial appendage electrical isolation reduce residual patency after device closure in patients with persistent atrial fibrillation?
Observational (n=469)
No
Does left atrial appendage electrical isolation reduce residual patency after device closure in patients with persistent atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Performing left atrial appendage electrical isolation during concomitant catheter ablation and left atrial appendage closure significantly reduces early surrogate LAA patency compared to standard ablation.
Background Left atrial appendage (LAA) patency after catheter ablation and LAA closure (LAAC) is a key determinant of postprocedure stroke. The effect of LAA electrical isolation (LAAEI) on LAA patency after LAAC in patients with atrial fibrillation (AF) remains unknown. Our objective was to explore the effect of LAAEI on LAA patency after catheter ablation and LAAC in patients with AF. Methods Patients with persistent AF who underwent combined catheter ablation and LAAC were enrolled. LAA patency was detected by cardiac computed tomographic angiography at 3 months after the procedure. Results A total of 686 patients with persistent AF with 3‐month device surveillance by cardiac computed tomographic angiography were included initially. Propensity score matching analysis was conducted on the basis of clinical features, echocardiographic parameters and procedural characteristics, and 469 patients were matched, including 363 with non‐LAAEI and 106 with LAAEI. Patients in matched groups showed 53.7% complete closure (no patency). Of the 46.3% of cases with LAA patency, visible peridevice leak was seen in 72.8%, and 27.2% had patency without visible peridevice leak. Compared with the non‐LAAEI group, the LAAEI group had a lower rate of LAA patency (49.6% versus 34.9%; adjusted odds ratio, 0.69 [95% CI, 0.48–0.98]; P =0.040). LAAEI was protective against LAA patency with an odds ratio of 0.68, and the other predictor of contrast leak into the LAA was maximum diameter of LAA orifice (odds ratio, 1.04 [95% CI, 1.00–1.08]; P =0.046). Conclusions LAAEI is an effective strategy for reducing LAA patency in patients with persistent AF undergoing combined catheter ablation and LAAC. Registration URL: clinicaltrials.gov ; Unique Identifier: NCT03788941.
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Yao et al. (2026) conducted an observational in Persistent Atrial Fibrillation (n=469). Left atrial appendage electrical isolation (LAAEI) vs. Standard ablation without attempted LAAEI was evaluated on Left atrial appendage patency detected by cardiac computed tomographic angiography at 3 months (adjusted OR 0.69, 95% CI 0.48-0.98, p=0.040). Left atrial appendage electrical isolation significantly reduced the rate of left atrial appendage patency compared with standard ablation (34.9% vs 49.6%; adjusted OR 0.69) in patients with persistent atrial fibrillation.
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