Why the study?
The combination of catheter ablation and left atrial appendage closure has emerged as a potential strategy for atrial fibrillation, but its efficacy and safety compared with catheter ablation alone required evaluation.
Does combined catheter ablation and left atrial appendage closure reduce thromboembolic events or arrhythmia recurrence compared to catheter ablation alone in patients with atrial fibrillation?
Does combined catheter ablation and left atrial appendage closure reduce thromboembolic events or arrhythmia recurrence compared to catheter ablation alone in patients with atrial fibrillation?
Combining catheter ablation with left atrial appendage closure does not reduce arrhythmia recurrence but increases the risk of procedural complications and thromboembolic events compared to ablation alone.
Avoid combined CA+LAAC due to higher thromboembolic and procedural risks; challenges presumed additive benefit and supports dedicated RCTs.
The combination of catheter ablation (CA) and left atrial appendage closure (LAAC) has emerged as a potential therapeutic strategy for patients with atrial fibrillation (AF). This systematic review and meta-analysis evaluated the efficacy and safety of the combined approach compared with CA alone. We conducted a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library from inception to January 10, 2025. Studies comparing CA plus LAAC with CA alone were included. Of 1,066 identified articles, 11 studies met the inclusion criteria. The mean follow-up duration ranged up to 24 months, with reported CHA₂DS₂-VASc scores ranging from 2.2 to 4.3 and HAS-BLED scores from 2.0 to 3.7. Meta-analysis showed no significant difference in thromboembolic events between the combined and control groups (RR: 1.42, 95% CI: 1.10-1.83, I² = 0%), and no significant difference in arrhythmia recurrence (RR: 1.02, 95% CI: 0.84-1.24, I² = 28%). However, the combined approach was associated with a significantly higher risk of procedural complications (RR: 1.61, 95% CI: 1.01-2.59, I² = 0%). These findings suggest that adding LAAC to CA does not reduce thromboembolic events or arrhythmia recurrence but may increase the risk of procedural complications. Given the predominance of observational studies and limited randomized controlled trial (RCT) data, larger high-quality trials are needed to more definitively assess the role of combined CA and LAAC in AF management.
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Rawat et al. (2025) studied this question.
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