Key result
Combined catheter ablation and LAAC linked to ~75% lower risk of embolic events versus LAAC alone.
Why the study?
The effect of an additional catheter ablation procedure on the risk of post-procedure adverse events during combined catheter ablation and left atrial appendage closure was unclear.
Does catheter ablation combined with left atrial appendage closure reduce embolic events and device-related thrombus compared to isolated left atrial appendage closure in patients with nonvalvular atrial fibrillation?
Cohort (n=361)
No
Does catheter ablation combined with left atrial appendage closure reduce embolic events and device-related thrombus compared to isolated left atrial appendage closure in patients with nonvalvular atrial fibrillation?
Hazard Ratio: 0.25 (95% CI 0.07–0.87)
Absolute Event Rate: 1.8% vs 5.1%
p-value: p=0.03
Combining catheter ablation with left atrial appendage closure appears safe and is associated with a reduced risk of long-term embolic events and device-related thrombus compared to appendage closure alone.
Combined ablation plus LAAC was associated with fewer embolic events; leaves open whether randomized trials will confirm benefit in nonvalvular AF.
(1) Background: This study aimed to investigate the effect of an additional catheter ablation (CA) procedure on the risk of post-procedure adverse events during CA combined with left atrial appendage closure (LAAC). (2) Methods: From July 2017 to February 2022, data from 361 patients with atrial fibrillation who underwent LAAC at our center were analyzed retrospectively. The adverse events were compared between CA + LAAC and LAAC-only groups. (3) Results: The incidence of device-related thrombus (DRT) and embolic events was significantly lower in the CA + LAAC group than in the LAAC-only group (p = 0.01 and 0.04, respectively). A logistic regression analysis revealed that the combined procedure served as a protective factor for DRT (OR = 0.09; 95% confidence interval: 0.01–0.89; p = 0.04). Based on a Cox regression analysis, the risk of embolism marginally increased in patients aged ≥65 years (HR = 7.49, 95% CI: 0.85–66.22 p = 0.07), whereas the combined procedure was found to be a protective factor (HR = 0.25, 95% CI: 0.07–0.87 p = 0.03). Further subgroup and interaction analyses revealed similar results. (4) Conclusions: The combined procedure may be associated with a lower rate of post-procedure DRT and embolization without a higher occurrence of other adverse events after LAAC. A risk-score-based prediction model was conducted, showing a good prediction performance.
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Zhang et al. (2023) conducted a cohort in Nonvalvular Atrial Fibrillation (n=361). Catheter ablation combined with left atrial appendage closure vs. Isolated left atrial appendage closure was evaluated on Embolic events (ischemic stroke, TIA, or pulmonary embolism) (HR 0.25, 95% CI 0.07-0.87, p=0.03). Catheter ablation combined with left atrial appendage closure significantly reduced the risk of long-term embolic events compared to isolated LAAC (HR 0.25, 95% CI 0.07-0.87) in patients with nonvalvular atrial fibrillation.
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