Safety and Efficacy of Left Atrial Ablation After Percutaneous Left Atrial Appendage Occlusion in High-Bleeding-Risk Patients with Atrial Fibrillation: A Multicenter Analysis from the PROCEED-AF Ablation Registry
Rachel M. KaplanJeanne du Fay de LavallazChristian‐Hendrik HeegerHakan OralMason YoderDavid SchaackK. R. Julian ChunBoris SchmidtJeffrey WinterfieldWilliam H. SauerFernando MorenoJonathan W. WaksAntonio Dello RussoPaolo CompagnucciPipin KojodjojoGhanshyam ShanthaLaurent RotenTobias ReichlinThomas KuefferKenneth BrownellSmit C VasaiwalaTimothy M. MarkmanPatrick BadertscherMichael KühneChristian SticherlingNishant VermaGraham PeighBradley P. KnightTom De PotterKonstantia Paraskevi GkiniDhiraj GuptaMark T MillsSerge BovédaRobin Richard-VittonJorge RomeroFengxiang ZhangRaktham MekritthikraiHenry D Huang
Key result
AF ablation after LAAO is feasible with ~7% bleeding risk on short-term OAC.
- n=198
Why the study?
Is catheter ablation for atrial fibrillation safe and feasible in patients with pre-existing LAAO devices?
Key Points
- Evaluate the procedural safety, clinical efficacy, and anticoagulation management patterns for catheter ablation in atrial fibrillation patients with pre-existing left atrial appendage occlusion devices.
- Multicenter registry analysis collecting clinical characteristics, procedural details, and outcomes across 14 international centers (PROCEED-AF Ablation Registry).
- Evaluated N=198 patients (median age 70 years, 37% female, 42% paroxysmal atrial fibrillation) with prior left atrial appendage occlusion undergoing catheter ablation a median of 271 days post-implant.
- Post-ablation oral anticoagulation was utilized in 84% of patients (most commonly for 2-3 months), with bleeding complications occurring in 6.7% at a median of 20 days post-procedure.
- Stroke or transient ischemic attack occurred in 2.6% of patients (5 cases overall, with 2 cases [1%] occurring the day after ablation), while new or worsened peri-device leak occurred in 2 patients.
Study Design
Type
Observational (n=198)
Multicenter
Yes
Structured PICO
Is catheter ablation for atrial fibrillation safe and feasible in patients with pre-existing LAAO devices?
P
Population
198 patients (mean age 70, 37% female) with atrial fibrillation and prior LAAO devices undergoing catheter ablation.
E
Exposure
Catheter ablation for atrial fibrillation performed a median of 271 days after LAAO, with post-ablation oral anticoagulation (OAC) management.
O
Outcome
Procedural safety, efficacy, and variability in management strategies (including bleeding complications, stroke/TIA, and peri-device leak).safety
Catheter ablation for AF in patients with pre-existing LAAO devices is feasible with rare device-related complications, and short-term OAC post-ablation is generally tolerated despite high bleeding risk.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Ablation in patients with an implanted LAAO device is safe despite the anticoagulation challenges in this patient population.”
Implication
Supports ablation feasibility in LAAO patients on short-term OAC; leaves open optimal strategies and long-term safety pending RCTs.
Abstract
BACKGROUND AND AIMS: Patients with left atrial appendage (LAAO) devices are increasingly referred for AF ablation, yet anticoagulation strategies remain uncertain. The goal of this study was to evaluate the safety and efficacy of catheter ablation for atrial fibrillation (AF) in patients with pre-existing LAAO devices and to describe patterns in anticoagulation management after ablation in this unique population. METHODS: We collected data from 14 centers worldwide on patients with prior LAAO devices undergoing AF ablation. Each site provided clinical characteristics, procedural details, and information on complications and arrhythmia outcomes. Data were aggregated and analyzed centrally to evaluate procedural safety, efficacy, and variability in management strategies. RESULTS: A total of 198 patients (age 70 years, 37% female, 42% paroxysmal AF) with prior LAAO were included. Ablation was performed a median of 271 days after LAAO. After ablation, 84% of patients were on oral anticoagulation (OAC), most commonly for 2-3 months. Bleeding complications on OAC occurred in 6.7% of patients at a median of 20 (13, 70) days after ablation. Stroke or TIA occurred in 5 patients (2.6% of cases) within the follow-up period with 2 occurrences (1% of cases) the day after ablation. There were 2 cases of new or worsened peri-device leak after ablation. CONCLUSION: In a large, international registry of patients undergoing catheter ablation for AF with pre-existing LAAO devices, ablation was feasible and device related complications were rare Despite higher bleeding risk in an LAAO population, 84% of patients with prior LAAO tolerated short term OAC post-ablation with bleeding events at expected rates for this population.
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Kaplan et al. (2026) conducted an observational in Atrial fibrillation (n=198). Catheter ablation was evaluated on Bleeding complications on OAC. Catheter ablation for AF in patients with prior LAAO devices was feasible, with 6.7% experiencing bleeding complications on short-term OAC and 2.6% experiencing stroke or TIA.