Combination of pulmonary vein isolation and left atrial appendage closure for non-valvular atrial fibrillation

Atrial fibrillation might occur up to 2% of the general population, with a lifetime risk of 24% in persons > 40 years of age. Catheter ablation is increasingly being used to treat drug-refractory atrial fibrillation. The long-term efficacy of catheter ablation is disappointing, with success rates about 50%. Stroke is one of the major complications of atrial fibrillation because of atrial thrombus formation. The overall annual stroke risk is 5% in patients with atrial fibrillation, increasing up to 15% in high-risk patients. The left atrial appendage was the source of thrombi in >90% of the patients with non-valvular atrial fibrillation. Anticoagulation should be given to prevent thromboembolic events. However, anticoagulant therapy has several disadvantages, such as (major) bleedings, interactions with some dietary components and other medications, and a narrow therapeutic range. In addition, patients with atrial fibrillation, especially the elderly, have low compliance. Exclusion of the left atrial appendage from the systemic circulation could be an alternative. Thus, the combination of the left atrial appendage closure with the isolation of the pulmonary veins appears to be a rational method for the treatment of atrial fibrillation. This approach eliminates the need for anticoagulants and reduces the risk of stroke.