Why the study?
Catheter ablation combined with left atrial appendage closure is feasible in atrial fibrillation, but the short-term safety and efficacy of combining cryoballoon ablation with LAAC in paroxysmal AF needed evaluation.
Does combining cryoballoon ablation with left atrial appendage closure improve outcomes or maintain safety compared to cryoballoon ablation alone in patients with nonvalvular, drug-refractory paroxysmal atrial fibrillation?
Does combining cryoballoon ablation with left atrial appendage closure improve outcomes or maintain safety compared to cryoballoon ablation alone in patients with nonvalvular, drug-refractory paroxysmal atrial fibrillation?
Combining cryoballoon ablation with left atrial appendage closure is a feasible and safe strategy for paroxysmal AF, with comparable adjusted 1-year efficacy to ablation alone.
Combined procedure remains viable without efficacy gain; leaves open superiority confirmation in randomized trials.
Background . Catheter ablation combined with left atrial appendage closure (LAAC) was reported as a feasible strategy for atrial fibrillation (AF) patients with high risk of stroke or contraindications of oral anticoagulants. We aimed to observe the short-term safety and efficacy of combining cryoballoon ablation (CBA) with LAAC in paroxysmal (PAF) patients. Method and Results . From Jan 2016 to Dec 2017, 304 patients diagnosed with nonvalvular, drug-refractory PAF were included, who underwent either CBA alone ( n = 262) or combined procedure ( n = 42). Instant pulmonary vein isolation (PVI) with CBA was achieved in all patients, while successful LAAC achieved in 41 (97.6%) of combined procedure patients. 1-year freedom of AF rate was lower in combined procedure group (84.7% vs 70.7%, p=0.04), with unadjusted hazard ratio (HR = 1.97) and 95% confidence interval (CI) 1.03–3.77. However, the multivariate COX model revealed left atrial diameter (p=0.002, HR = 1.10, and 95% CI 1.04, 1.17), rather than procedure type (p=0.51, HR = 1.34, and 95% CI 0.57, 3.17), was the predictor for freedom of AF. Only 2 patients in the CBA group had stroke, contributing to the nonsignificant higher stroke incidence (p=1.00). Transoesophageal echochardiography (TEE) achieved in 35 patients (83.3%) showed complete occlusion with no obvious residual flow (>3 mm), Device-related thrombosis, or pericardial perfusion. All-cause mortality, rehospitalization, and complication rates were similar. Conclusion . Combining CBA with LAAC in a single procedure is a feasible strategy for PAF patients, with comparable short-term safety and efficacy to CBA alone.
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Ren et al. (2020) studied this question.
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