Long‐Term Safety and Feasibility of Delayed Left Atrial Appendage Closure After Catheter Ablation

Background: This study aimed at comparing the safety and long‐term outcomes pertaining to delayed left atrial appendage closure (LAAC) after catheter ablation (CA). Methods: The retrospective analysis in the study included 474 patients who received LAAC at our center between July 2017 and April 2024. Procedure‐ and device‐related complications, major adverse events (MAEs), and recurrence of atrial fibrillation (AF) were compared among the CA + LAAC, Delayed‐LAAC, and LAAC‐only groups. Results: The Delayed‐LAAC group did not report device‐related thrombus (DRT) formation, and the CA + LAAC group presented obviously lower DRT incidence versus the LAAC‐only group (0.7% vs. 7.1%, p = 0.02). Both CA + LAAC and Delayed‐LAAC groups exhibited obviously lower stroke events rate versus the LAAC‐only group (4.6% and 2% vs. 13.7%, p = 0.02). And all three groups demonstrated low rates of bleeding events (9.8% and 6% vs. 3.4%, p = 0.25) and all‐cause death (1.9% and 2% vs. 5.2%, p = 0.23). The Delayed‐LAAC group showed dramatically lower AF recurrence rate relative to the CA + LAAC group (16% vs. 35.2%, p = 0.006). In the multivariate Cox regression analysis, delayed LAAC (hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.20–0.93, and p = 0.03) and paroxysmal AF (HR = 0.56, 95% CI: 0.38–0.83, and p = 0.003) were protective factors. Patients with persistent AF and who once had been diagnosed with coronary heart disease (HR = 1.56, 95% CI: 1.11–2.21, and p = 0.01) were more likely to experience AF recurrence. Further subgroup analysis showed similar results. Conclusions: The Delayed‐LAAC is as safe and feasible as the combination procedure. However, Delayed‐LAAC was associated with lower AF recurrence rate.