Combination of left atrial appendage closure and catheter ablation in a single procedure for patients with atrial fibrillation: Multicenter experience

Du, Xianfeng; He, Bin; Han, Xu; Shubin, Jiang; Miao, Lin; Lin, Rong; Liu, Jing; Wang, Binhao; Feng, Mingjun; Yu, Yi; Chen, Xiaomin

doi:10.1016/j.jfma.2018.10.006

Cited by 20 publications

(18 citation statements)

References 23 publications

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“…The procedural-related complication/serious adverse event rate of combined therapy reported by two multicenter studies was 6.2% and 2.1% [ 9 , 12 ], which was consistent with the results of this study. A Chinese multicenter registry with the same population of our study documented a similar rate of 4.1% [ 11 ]. Our results support good periprocedural safety of the combined procedure.…”

Section: Discussionsupporting

confidence: 71%

Combined Therapy of Catheter Ablation and Left Atrial Appendage Closure for Patients with Atrial Fibrillation: A Case-Control Study

Sun

Zhang

et al. 2020

Journal of Interventional Cardiology

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Aim. The feasibility and safety of performing the combined procedure of catheter ablation (CA) and left atrial appendage closure (LAAC) for atrial fibrillation (AF) have been reported by observational studies without controls. The aim of this study was to compare the procedural and long-term outcomes of combined procedures with isolated CA or LAAC. Methods and Results. This study included patients who underwent combined CA and LAAC (combined group), CA alone (CA-only group), or LAAC alone (LAAC-only group). Propensity score matching was used to select controls from the CA-only and LAAC-only groups. Each group contained 76 subjects. The procedures were successfully performed in all the patients. Procedure-related complications of the combined group included one pericardial effusion and two groin haematomas, which did not differ significantly with those of the CA-only group (3.9% vs. 2.6%, P=0.650) or the LAAC-only group (3.9% vs. 2.6%, P=0.650), respectively. The AF-free rate of the combined group was comparable with that of the CA-only group after a mean of 2 years follow-up (67.1% vs. 69.7%, P=0.727). Compared with the LAAC-only group, the combined group achieved similar complete occlusion rate at implant (94.7% vs. 93.4%) and at 45 days (82.9% vs. 85.5%). At the end of follow-up, ischemic stroke and bleeding events of the combined group were low (3.9%) and were comparable with those of the CA-only group (5.3%) and the LAAC-only group (2.6%). Conclusions. The combination of AF-CA and LAAC is safe and efficacious compared with single procedures alone.

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Section: Discussionsupporting

confidence: 71%

Combined Therapy of Catheter Ablation and Left Atrial Appendage Closure for Patients with Atrial Fibrillation: A Case-Control Study

Sun

Zhang

et al. 2020

Journal of Interventional Cardiology

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“…In addition, catheter might potentially damage, dislodge and be entrapped by the device. Despite a previous study reporting similar outcomes as to performing ablation first or LAAC first, [ 28 ] we recommend performing ablation prior to LAAC.…”

Section: Discussionmentioning

confidence: 80%

One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure

Chen

Wang

et al. 2020

Chinese Medical Journal

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Background Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure. Methods Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively. Results A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA 2 DS 2 -VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed. Conclusion Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.

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“…Of these, 41 studies were further excluded because the index data were not available or effectively evaluated. The remaining 18 studies comprising two RCTs and 16 observational studies satisfied the inclusion criteria and were eventually included in this meta‐analysis. The literature search was conducted by two independent researchers (YJ and FL).…”

Section: Resultsmentioning

confidence: 99%

“…With regard to ablation strategy, one study used cryoballoon ablation, one study used RA and cryoballoon ablation, and the others used RA. As for the closure device, 11 studies used WATCHMAN (Boston Scientific, Natick, MA, USA), one study used LAmbre (Lifetech Scientific Corp., Shenzhen, China), and the other six studies used two closure devices: Amplatzer Cardiac Plug device (St. Jude Medical, Inc., St. Paul, MN, USA) and WATCHMAN. However, the outcomes were not reported separately based on each device.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of catheter ablation combined with left atrial appendage occlusion for nonvalvular atrial fibrillation: A systematic review and meta‐analysis

Jiang

et al. 2019

Pacing Clinical Electrophis

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Atrial fibrillation (AF) is currently the most prevalent arrhythmia in clinical practice, with stroke being one of its major complications. Combining catheter ablation and percutaneous left atrial appendage occlusion (LAAO) into a "one-stop" intervention could reduce stroke incidence in selected high-risk patients and, at the same time, relieve AF symptoms in a single procedure.This meta-analysis analyzed the efficacy and safety of catheter ablation combined with LAAO for nonvalvular AF. PubMed, EMBASE, and the Cochrane Library were searched from inception to April 2019 to identify relevant citations. Efficacy indexes were procedural success, AF recurrence, stroke/transient ischemic attacks (TIA), and device-related thrombus (DRT). Safety indexes were all-cause death, major hemorrhagic complications, and pericardial effusion/cardiac tamponade. The incidence rate of events (ratio of events to patients) and 95% confidence interval (CI) were calculated as summary results. A forest plot was constructed to present pooled rates. Eighteen studies (two randomized controlled trials and 16 observational studies) were included. The results showed that one-stop intervention has significant efficacy and safety, with procedural success of .98 (95% CI, .97-1.00), AF recurrence of .24 (95% CI, .15-.35), stroke/TIA of .01 (95% CI, .00-.01), DRT of .00 (95% CI, .00-.01), all-cause mortality of .00 (95% CI, .00-.00), cardiac/neurological mortality of .00 (95% CI, .00-.00), major hemorrhagic complications of .01 (95% CI, .00-.02), and pericardial effusion/cardiac tamponade of .01 (95% CI, .00-.01). A single procedure with catheter ablation and LAAO in AF is a feasible strategy with significant efficacy and safety. K E Y W O R D Satrial fibrillation, catheter ablation, left atrial appendage occlusion, stroke prevention

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Combination of left atrial appendage closure and catheter ablation in a single procedure for patients with atrial fibrillation: Multicenter experience

Cited by 20 publications

References 23 publications

Combined Therapy of Catheter Ablation and Left Atrial Appendage Closure for Patients with Atrial Fibrillation: A Case-Control Study

Combined Therapy of Catheter Ablation and Left Atrial Appendage Closure for Patients with Atrial Fibrillation: A Case-Control Study

One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure

Efficacy and safety of catheter ablation combined with left atrial appendage occlusion for nonvalvular atrial fibrillation: A systematic review and meta‐analysis

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