Key result
Combined ablation and LAAC achieves comparable AF-free rates to ablation alone without increasing complications.
Why the study?
The feasibility and safety of combined catheter ablation and left atrial appendage closure for AF had been reported without controls, leaving procedural and long-term outcomes compared with isolated procedures unassessed.
Does combined catheter ablation and left atrial appendage closure improve procedural and long-term outcomes compared to single procedures alone in patients with nonvalvular atrial fibrillation?
Case-Control (n=228)
No
Does combined catheter ablation and left atrial appendage closure improve procedural and long-term outcomes compared to single procedures alone in patients with nonvalvular atrial fibrillation?
Combining catheter ablation and left atrial appendage closure in a single procedure appears safe and effective, offering comparable rhythm control and stroke prevention to isolated procedures without adding periprocedural risks.
Answers are grounded in this paper and cite their sources.
Comparable outcomes support combined procedure feasibility in matched AF patients; hypothesis-generating and should not change practice without RCTs.
Aim . The feasibility and safety of performing the combined procedure of catheter ablation (CA) and left atrial appendage closure (LAAC) for atrial fibrillation (AF) have been reported by observational studies without controls. The aim of this study was to compare the procedural and long-term outcomes of combined procedures with isolated CA or LAAC. Methods and Results . This study included patients who underwent combined CA and LAAC (combined group), CA alone (CA-only group), or LAAC alone (LAAC-only group). Propensity score matching was used to select controls from the CA-only and LAAC-only groups. Each group contained 76 subjects. The procedures were successfully performed in all the patients. Procedure-related complications of the combined group included one pericardial effusion and two groin haematomas, which did not differ significantly with those of the CA-only group (3.9% vs. 2.6%, P=0.650) or the LAAC-only group (3.9% vs. 2.6%, P=0.650), respectively. The AF-free rate of the combined group was comparable with that of the CA-only group after a mean of 2 years follow-up (67.1% vs. 69.7%, P=0.727). Compared with the LAAC-only group, the combined group achieved similar complete occlusion rate at implant (94.7% vs. 93.4%) and at 45 days (82.9% vs. 85.5%). At the end of follow-up, ischemic stroke and bleeding events of the combined group were low (3.9%) and were comparable with those of the CA-only group (5.3%) and the LAAC-only group (2.6%). Conclusions . The combination of AF-CA and LAAC is safe and efficacious compared with single procedures alone.
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Mo et al. (2020) conducted a case-control in Nonvalvular atrial fibrillation (n=228). Combined catheter ablation and left atrial appendage closure vs. Catheter ablation alone was evaluated on AF-free rate (p=0.727). Combined catheter ablation and left atrial appendage closure achieved an AF-free rate comparable to catheter ablation alone without increasing procedure-related complications.
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