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

Jiang, Ying; Li, Fanghui; Li, Dongze; Cheng, Yisong; Ji, Yu; Fu, Hua; Pu, Xiaobo; Hu, Hongde; Jiang, Jian; Zeng, Rui

doi:10.1111/pace.13845

Cited by 14 publications

(24 citation statements)

References 40 publications

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“…The pooled rates of device embolization and other bleeding events were as low as 0.01, and the average annualized bleeding rate reduction was as high as 60.3%. The results of the long-term adverse events were likely to previous studies, 15,16 indicating this combined procedure had a reliable performance on safety.…”

Section: Discussionsupporting

confidence: 54%

“…In the case of efficacy outcomes, the results showed the combined procedure had a high rate of 1.00 in long-term successful sealing of LAAC, similar to recent meta-analysis results with a successful sealing rate of 0.98. 16 The pooled rate of ischemic stroke/TIA/systemic embolism during follow-up was as low as 0.01. Importantly, the average annualized stroke rate reduction was as high as 79.7%.…”

Section: Discussionmentioning

confidence: 93%

“…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. 23,24 In this study, we evaluated the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety of the combination of ablation and LAAC.…”

Section: Introductionmentioning

confidence: 99%

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

Sun

et al. 2021

Cardiovasc electrophysiol

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Background: Combined ablation and left atrial appendage closure (LAAC) is an alternative for atrial fibrillation patients with a high risk of stroke. However, the long-term outcomes of this combined procedure remain elusive.Methods: PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included.Results: A total of 16 studies comprising 1428 patients were enrolled. The pooled long-term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval[CI]: 0.59-0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI:1.00-1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow-up was 0.01 (95% CI: 0.00-0.02). Meanwhile, of the periprocedural adverse events, phrenic nerve palsy, intracoronary air embolus, device embolization, and periprocedural death had a rate of 0.00 (95% CI: 0.00-0.00), procedure-related bleeding events of 0.03 (95% CI: 0.02-0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI: 0.00-0.01). Moreover, for the long-term adverse events, device dislocation, intracranial bleeding, pericardial effusion requiring or not requiring intervention, and all-cause mortality had a rate of 0.00 (95% CI: 0.00-0.00), device embolization of 0.01 (95% CI: 0.00-0.01), and other bleeding events of 0.01 (95% CI: 0.00-0.03). Conclusion:This meta-analysis suggests that the combined atrial ablation and LAAC is an effective and safe strategy with long-term benefits.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

Sun

et al. 2021

Cardiovasc electrophysiol

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“…A recent study from China revealed that the immediate success rate of LAAC after CA was 100 percent 21 . What is more, a meta‐analysis of 18 studies showed that the one‐stop procedure had a 98% procedural success rate of LAAC 22 . Different success rate of device implantation in the combination procedure may be associated with patient volume and operator's experience.…”

Section: Important Issues To Be Considered In the Combination Proceduresmentioning

confidence: 99%

Combination of ablation and left atrial appendage closure as “One‐stop” procedure in the treatment of atrial fibrillation: Current status and future perspective

Jiang

Hao

et al. 2021

Pacing Clinical Electrophis

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Atrial fibrillation (AF), the most common arrhythmia, is a major cause of stroke and systemic embolism. Left atrial appendage closure (LAAC) has been proved to be noninferior to traditional Vitamin K antagonists (VKAs) as well as novel oral anticoagulants (NOACs), which is becoming an important alternative to prevent stroke in non‐valvular AF. Catheter‐based AF ablation (CA) is recommended to be a standard of care in patients with AF refractory to drug therapy due to a better rhythm control and improvement of life quality than antiarrhythmic drugs. Theoretically, the one‐stop combination with LAAC and CA tends to bring more benefits in patients with AF, as it not only relieves symptoms, but also reduces the risk of stroke significantly. However, several important questions still need to be considered in the combination procedure although quite a few attempts have already been made in clinical practice. This review provides a comprehensive update on the concept, technique, perioperative management, benefits and other critical issues of the “one‐stop” procedure.

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“…Recently, Jiang et al conducted a meta-analysis on the efficacy and safety of CA combined with LAAO, concluding that a single procedure combining these 2 approaches is a feasible strategy with significant levels of efficacy and safety. 3 Therefore, one-stop intervention may become increasingly common in clinical practice in the future.…”

Section: Introductionmentioning

confidence: 99%

Device-Related Thrombosis in Patients Receiving One-Stop Intervention for Nonvalvular Atrial Fibrillation: A Systemic Review and Meta-Analysis

Tang

Zhang

2021

Clin Appl Thromb Hemost

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This study aimed to assess the incidence, clinical implications, and treatment strategies of device-related thrombus (DRT) following catheter ablation and percutaneous left atrial appendage occlusion combined in one intervention. A meta-analysis of observational studies was conducted to evaluate the incidence rates, treatment strategies, and clinical implications of DRT. A total of 21 studies describing DRT events and 1 case were included in the current study. The 21 included studies comprised 3 multi-center registries and 18 single-center registries, and we also included 1 case report analyzing the characteristics of DRT. The pooled incidence of DRT in one-stop intervention was 18/1,708 (1.2%; range = 0%-7.3%; 95% CI = 0.7%-1.8%; I 2 = 0). Of these DRT events, 56.25% were diagnosed in the first 3 months after the procedure. All cases were diagnosed via trans-esophagus echocardiogram. All of the patients diagnosed with DRT were prescribed anticoagulation treatment, and 63% (12/19) of the events were reported with an outcome of complete thrombus resolution. The duration of anticoagulation treatment varied greatly, from 30 days to 6 months. Unknown clinical events were reported relating to DRT. Device-related thrombus is an uncommon complication of one-stop intervention. It occurs mainly in the early period following the procedure. Anticoagulation appears to be an appropriate treatment method for dissolving occurrences of DRT.

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

Cited by 14 publications

References 40 publications

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

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

Combination of ablation and left atrial appendage closure as “One‐stop” procedure in the treatment of atrial fibrillation: Current status and future perspective

Device-Related Thrombosis in Patients Receiving One-Stop Intervention for Nonvalvular Atrial Fibrillation: A Systemic Review and Meta-Analysis

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