Combining Watchman left atrial appendage closure and catheter ablation for atrial fibrillation: multicentre registry results of feasibility and safety during implant and 30 days follow-up

Abstract

AimsLong-term results from catheter ablation therapy for atrial fibrillation (AF) remain uncertain and clinical practice guidelines recommend continuation of long-term oral anticoagulation in patients with a high stroke risk. Left atrial appendage closure (LAAC) with Watchman has emerged as an alternative to long-term anticoagulation for patients accepting of the procedural risks. We report on the initial results of combining catheter ablation procedures for AF and LAAC in a multicentre registry.Methods and resultsData were pooled from two prospective, real-world Watchman LAAC registries running in parallel in Europe/Middle-East/Russia (EWOLUTION) and Asia/Australia (WASP) between 2013 and 2015. Of the 1140 patients, 139 subjects at 10 centres underwent a concomitant AF ablation and LAAC procedure. The mean CHA2DS2-VASc score was 3.4 ± 1.4 and HAS-BLED score 1.5 ± 0.9. Successful Watchman implantation was achieved in 100% of patients. The overall 30-day serious adverse event (SAE) rate was 8.7%, with the device and/or procedure-related SAE rate of 1.4%. One pericardial effusion required percutaneous drainage, but there were no strokes, device embolization, or deaths at 30 days. The 30-day bleeding SAE rate was 2.9% with 55% of patients prescribed NOAC and 38% taking warfarin post-procedure.ConclusionThe outcomes from these international, multicentre registries support the feasibility and safety of performing combined procedures of ablation and Watchman LAAC for patients with non-valvular AF and high stroke risk. Further data are needed on long-term outcomes for the hybrid technique on all-cause stroke and mortality.

Optimal combination strategy of left atrial appendage closure plus catheter ablation in a single procedure in patients with nonvalvular atrial fibrillation

“…The Watchman device did not interfere with a repeat ablation. Similar experience had been reported in other single‐ and multicenter studies . The 5‐year outcomes of combination therapy (LAAC with the Watchman device and CA for AF) also indicated the long‐term efficacy and safety .…”

“…Magnetic resonance imaging assessment of the LAA in an 8‐patient study indicated nonsignificant increase and decrease of LAA diameters and area within 48 hours of and 3 months post‐AF ablation, providing reassurance for concomitant AF CA and LAAC . In fact, the ablation‐first strategy was adopted in several combination studies with implantation of Watchman devices . However, acute and subacute radiofrequency tissue injury presenting as edema in this region might be a deterrent, causing peridevice leak.…”

“…Similar experience had been reported in other single-and multicenter studies. 5,6,14 The 5-year outcomes of combination therapy (LAAC with the Watchman device and CA for AF) also indicated the long-term efficacy and safety. 5 Concomitant cryoballoon ablation and LAAC devices were also demonstrated to be efficacious.…”

“…Patients with contraindications for chronic oral anticoagulation (OAC) could also benefit from LAAC . Recently, the efficacy and safety of the concomitant therapy of CA for AF symptom relief and LAAC for stroke prevention in a single procedure have been assessed . The advantages of the combined procedures are measurable; however, the optimal combination strategy has not been discussed.…”

“…assessed. [5][6][7] The advantages of the combined procedures are measurable; however, the optimal combination strategy has not been discussed. We report the impact of various concomitant strategies on clinical outcomes.…”