Key result
Left atrial appendage closure within 3 months after ablation significantly reduced major and clinically relevant nonmajor bleeding compared to DOACs (HR 0.417; 95% CI 0.181-0.960; p=0.034).
Why the study?
Inadvertent left atrial appendage electrical isolation during persistent AF ablation increases thromboembolic risk, but the optimal antithrombotic strategy remains unclear.
Does left atrial appendage closure reduce bleeding and thromboembolic events compared to long-term DOACs in patients with inadvertent left atrial appendage electrical isolation during persistent AF ablation?
Cohort (n=144)
No
Does left atrial appendage closure reduce bleeding and thromboembolic events compared to long-term DOACs in patients with inadvertent left atrial appendage electrical isolation during persistent AF ablation?
In patients with inadvertent LAAEI during persistent AF ablation, performing LAAC within 3 months reduces bleeding risk compared to long-term DOACs while maintaining comparable thromboembolic protection.
Background Inadvertent left atrial appendage electrical isolation (LAAEI) during persistent atrial fibrillation (AF) ablation increases thromboembolic risk. The optimal antithrombotic strategy for these patients remains unclear. Objectives This study aimed to compare the safety and efficacy of left atrial appendage closure (LAAC) performed within 3 months after catheter ablation versus long‐term postoperative received direct oral anticoagulants (DOACs) in patients with persistent AF who experienced inadvertent LAAEI during catheter ablation. Methods The single‐center retrospective analysis included 225 patients with inadvertent LAAEI during persistent AF ablation between January 2019 and March 2024. After propensity score matching (PSM), 144 patients were analyzed: 72 received LAAC (LAAC group), and 72 received DOACs (DOAC group). Outcomes, including bleeding and thromboembolic events, were assessed over a mean follow‐up of 827 days. Results The LAAC group had significantly fewer non‐procedure‐related major and clinically relevant nonmajor bleeding events compared to the DOAC group (HR = 0.417, 95% CI: 0.181–0.960, p = 0.034). Thromboembolic events were similar (HR = 0.246, 95% CI: 0.071–0.851, p = 0.205). Atrial arrhythmia recurrence rates were comparable (HR = 0.939, 95% CI: 0.587–1.502, p = 0.054). Normal LAA function was observed in 41.67% of the DOAC group, while the LAAC group had two cases of device‐related thrombus resolved with anticoagulation. Conclusions LAAC within 3 months after catheter ablation may reduce bleeding risk while maintaining efficacy comparable to long‐term DOACs in patients with inadvertent LAAEI. LAAC represents a safe and effective strategy for this population.
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Wu et al. (2026) conducted a cohort in Persistent atrial fibrillation with inadvertent left atrial appendage electrical isolation (n=144). Left atrial appendage closure (LAAC) vs. Direct oral anticoagulants (DOACs) was evaluated on Non-procedure-related major and clinically relevant nonmajor bleeding events (HR 0.417, 95% CI 0.181-0.960, p=0.034). Left atrial appendage closure within 3 months after ablation significantly reduced major and clinically relevant nonmajor bleeding compared to DOACs (HR 0.417; 95% CI 0.181-0.960; p=0.034).
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