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

Abstract

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.

Effect of Left Atrial Appendage Closure in Combination With Catheter Ablation on Left Atrial Function for Persistent Atrial Fibrillation

“…Our results showed that the AF recurrence rate of the combined group was comparable with that of the CA-only group during 1 years follow-up, indicating that additional LAAC did not influence the recurrence rate of atrial fibrillation. This finding is in line with previous literature (24,25). Moreover, Persistent AF, even long-standing persistent AF, is difficult to treat inasmuch as arrhythmia recurs at significant rates after catheter ablation therapy.…”

Combined Catheter Ablation and Left Atrial Appendage Closure in Atrial Fibrillation Patients with and without Prior Stroke

“…After a mean follow-up of 726 ± 91 days, the annualized stroke and major bleeding rates were 1.09% and 1.09%, respectively. We recently reported the results of the combined procedure in a case-control study using the propensity score matching method [ 7 ]. Outcomes of the combined procedure with ablation alone and LAAC alone were compared.…”

“…The combined procedure was performed as described previously [ 7 ]. AF ablation was performed before LAAC implantation.…”

The long‐term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and meta‐analysis

“…The flowchart of the study selection process was shown in Figure 1. In total, 16 studies were included, 13,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and one of the studies was divided into two arms for meta-analysis according to the procedural strategies (First LAAC then RFA or First FRA then LAAC), 35…”

“…12 Preliminary studies showed that the procedure of combined ablation and LAAC could be performed successfully and safely, with a more than 95% success rate and a less than 5% periprocedural adverse event. 13,14 Additionally, meta-analyses revealed the short-term efficacy and safety of the combined procedure for AF patients with high stroke risk. 15,16 Despite the promising results, the limitation of previous studies should be highlighted, including a small sample size (e.g., less than ten patients), [17][18][19] lack of long-term follow-up (e.g., less than 6 months), [20][21][22] and noncombined ablation and LAAC.…”