Key result
Combined ablation and LAAC transiently impairs left atrial function at 3 months, with full recovery by 1 year.
Why the study?
The impact of left atrial appendage closure following catheter ablation on left atrial structure and functioning in patients with paroxysmal atrial fibrillation was not well defined.
Does catheter ablation combined with left atrial appendage closure impair left atrial mechanical function compared to catheter ablation alone in patients with paroxysmal atrial fibrillation?
Cohort (n=178)
Open-label
Propensity score matching
No
Does catheter ablation combined with left atrial appendage closure impair left atrial mechanical function compared to catheter ablation alone in patients with paroxysmal atrial fibrillation?
Concomitant left atrial appendage closure with catheter ablation for paroxysmal atrial fibrillation causes a transient mechanical decline in left atrial function that fully normalizes by 12 months.
Answers are grounded in this paper and cite their sources.
Transient LA impairment after combined ablation-LAAC should not change practice; leaves open whether randomized trials confirm full functional recovery in paroxysmal AF.
Objective: In the present study, we investigated the impact of left atrial appendage closure (LAAC) following catheter ablation (CA) on the left atrial structure and functioning of patients with paroxysmal atrial fibrillation (AF). Methods: Patients with paroxysmal AF were enrolled in this single-center prospective cohort study between April 2015 and July 2021; 353 patients received CA alone, while 93 patients received CA in combination with Watchman LAAC. We used age, gender, CHA2DS2-VASc, and HAS-BLED scores as well as other demographic variables to perform propensity score matching. Patients with paroxysmal AF were randomly assigned to the CA combined with Watchman LAAC group (combined treatment group) and the simple CA group, with 89 patients in each group. The left atrial structure, reserve, ventricular diastole, and pump functions and their changes in patients were assessed using routine Doppler echocardiography and 2D speckle tracking echocardiography over the course of a 1-year follow-up. Results: At 1-week follow-up, the reserve, ventricular diastole, and pump functions of the left atrium (LA) increased in both groups; these functions were gradually restored at the 1- to 3-month follow-up; they were close to or returned to their pre-operative levels at the 3-month follow-up; and no significant differences were found compared with the pre-operative levels at the 12-month follow-up. In the first 3 months, the reserve (Ƹ, SRs) and pump functions (SRa) in the combined treatment group decreased significantly when compared with the simple CA group, and the differences were statistically significant. Conclusion: Patients with paroxysmal AF may experience a short term, partial effect of LAAC on LA reserve and pump functions, which are gradually restored and the effect disappears by 12 months.
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Lv et al. (2024) conducted a cohort in Paroxysmal non-valvular atrial fibrillation (n=178). Catheter ablation combined with left atrial appendage closure (Watchman) vs. Catheter ablation alone was evaluated on Left atrial reserve and pump functions at 3 months (p=<0.05). Catheter ablation combined with left atrial appendage closure transiently reduced left atrial reserve and pump functions in the first 3 months compared to ablation alone, but functions fully recovered by 12 months.
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