Combined left atrial appendage occlusion and catheter ablation procedure for left atrial arrhythmias: A real‐world, propensity‐matched analysis

Introduction Real‐world studies comparing safety and efficacy of combined percutaneous left atrial appendage occlusion (LAAO) and catheter ablation (CA) to LAAO alone are limited. Methods Patients from a large US hospital system undergoing combined LAAO and left‐atrial CA from 8/2020 to 2/2024 were retrospectively analyzed and compared to a control group undergoing LAAO alone. Controls were identified using a 1:2 propensity score match based on LAAO device type (Watchman FLX vs. Amulet), CHA 2 D 2 ‐VASc and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio [INR], Elderly, Drugs/alcohol (HAS‐BLED) scores and compared for safety, sealing performance and clinical outcomes at 6 months. Results Patients were younger in the combined ( n = 72) than in the control group ( n = 144, 70.2 ± 7.3 vs. 76.7 ± 6.9 years, p < 0.001) but otherwise comparable with a mean CHA 2 D 2 ‐VASc score of 4.2 ± 1.1 and 4.4 ± 1.2 ( p = 0.26) and HAS‐BLED score of 2.2 ± 0.8 and 2.3 ± 0.7 ( p = 0.34). Successful LAAO implantation rates were the same (95.8% vs. 95.8%, p = 0.99) with longer procedure times seen in the combined group (156.5 ± 53 vs. 56 ± 26 min, p < 0.001). Both major (1.4% vs. 2.1%, p = 0.72) and minor (27.8% vs. 19.4%, p = 0.17) in‐hospital complications were similar between the combined and control group, respectively. At 45 days, presence of peri‐device leak (18.3% vs. 30.4%, p = 0.07) and device related thrombosis (4.5% vs. 4.5%, p = 0.96) on transesophageal echocardiogram did not differ. Finally, all‐cause mortality (0% vs. 1.4%, p = 0.99), thromboembolic (0% vs. 0%, p = 0.99) and bleeding (6.1% vs. 4.4%, p = 0.73) events during follow‐up were comparable. Conclusion This large, real‐world analysis indicates comparable safety and efficiency of combined LAAO and CA when compared with LAAO alone.