Concomitant atrial fibrillation ablation and left atrial appendage occlusion: rationale, outcomes, and future directions

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and remains a major contributor to stroke, heart failure, hospitalization, and cardiovascular mortality. Catheter ablation has become a central strategy for rhythm control, while left atrial appendage occlusion (LAAO) offers an effective mechanical option for stroke prevention in patients with contraindications to oral anticoagulation. Performing AF ablation and LAAO during the same procedure addresses complementary therapeutic goals while potentially improving procedural efficiency, reducing hospital exposure, and enhancing patient convenience. This narrative review summarizes the rationale, patient selection, procedural considerations, clinical outcomes, and future directions of concomitant AF ablation and LAAO. Evidence demonstrates high procedural success rates, generally exceeding 90%, with acceptable acute complication rates in experienced centers. Combined procedures benefit from shared transseptal access, consolidated imaging and anesthesia requirements, and a single recovery period. Rhythm-control efficacy compared with standalone ablation remains unclear, with recurrence rates reported as both elevated and comparable across studies, reflecting the limited randomized data for concomitant procedures. Important knowledge gaps persist regarding optimal sequencing, periprocedural antithrombotic therapy, patient selection, and newer technologies such as pulsed-field ablation. Concomitant AF ablation and LAAO represent a logical and evolving strategy for integrated rhythm and stroke management.