Key result
Concomitant AF ablation and LAAC achieved a 91.6% LAAC success rate and a 6.2% periprocedural complication rate, allowing anticoagulation discontinuation in 93.8% of patients.
Why the study?
Catheter ablation is effective for AF and LAAC is an alternative for stroke prevention, but the safety and efficacy of combining them in a single procedure needed assessment.
Observational
Combining AF ablation and LAAC in a single procedure is feasible and allows for successful discontinuation of anticoagulation in the vast majority of patients, though it carries a 6.2% periprocedural complication rate.
Supports feasibility of combined procedure with high anticoagulation discontinuation; hypothesis-generating and requires randomized confirmation before practice change.
Background: Catheter ablation is an effective therapy in the management of atrial fibrillation (AF). Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention in patients with bleeding risks. Objectives: The purpose of this study was to assess the safety and efficacy of combining AF ablation and LAAC in a single procedure. Methods: This retrospective observational study included consecutive patients who underwent concomitant AF ablation and LAAC between June 2015 and August 2021. We assessed the safety and efficacy of the combined procedure with respect to procedural success, periprocedural complications, thromboembolism, bleeding, and arrhythmia recurrence. Results: VASc and HAS-BLED scores were 4.0 ± 1.4 and 2.8 ± 1.1, respectively. Pulmonary vein isolation was achieved in all patients. LAAC was aborted in 15 cases (success rate of 91.6%). The periprocedural complications rate was 6.2%. The median follow-up duration was 412 days IQR: 213 to 781 days. There were 2 strokes and 3 transient ischemic attacks, equating to an annual risk of 1.7% at 1 year and 4.6% at 2 years. Complete seal was achieved in 97.5% intraprocedurally and in 73.7% on initial follow-up, with no major leaks identified. There were 2 cases (1.3%) of device-related thrombus that resolved with anticoagulation. Thirty-four bleeding events occurred in 28 patients (17.4%). Anticoagulation was discontinued in 93.8% of patients. Conclusions: Concomitant AF ablation and LAAC could be considered in appropriate patients in centers of clinical expertise.
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Alzahrani et al. (2024) conducted an observational in Atrial fibrillation. Concomitant AF ablation and LAAC was evaluated on Procedural success, periprocedural complications, thromboembolism, bleeding, and arrhythmia recurrence. Concomitant AF ablation and LAAC achieved a 91.6% LAAC success rate and a 6.2% periprocedural complication rate, allowing anticoagulation discontinuation in 93.8% of patients.