Long-term outcome of combined catheter ablation and left atrial appendage closure in atrial fibrillation patients

Mu, Chunlai; Sun, Jian; Wang, Qunshan; Zhang, Peng‐Pai; Li, Wei; Zhang, Rui; Mo, Bin‐Feng; Yu, Yongsheng; Cai, Xiaojing; Yang, Mei; Lian, Xiao-Ming; Zhao, Yan; Gong, Chang-Qi; Yu, Yi; Liu, Bo; Feng, Xiang‐Fei; Lu, Qiuchen; Li, Yi‐Gang

doi:10.1016/j.ijcard.2022.08.007

Cited by 14 publications

(11 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For middle‐aged and elderly patients with atrial fibrillation, due to many comorbidities, high risk of thrombosis and bleeding, and relatively high recurrence rate of radiofrequency ablation, catheter ablation combined with percutaneous left atrial appendage occlusion (“one‐stop” procedure) can be used. Previous studies (Chen et al, 2022) have confirmed that “one‐stop” procedure is safe and effective. This study analyzed the effects of different treatment strategies (drug therapy, radiofrequency ablation, “one‐stop” procedure, left atrial appendage closure) on prognosis and quality of life in patients with atrial fibrillation, in order to provide a basis for clinical strategy selection.…”

Section: Introductionmentioning

confidence: 82%

Effects of different interventions on prognosis and quality of life in patients with atrial fibrillation

Wang

Huang

et al. 2022

Noninvasive Electrocardiol

View full text Add to dashboard Cite

Objective To compare the effects of different intervention measures on prognosis and quality of life in patients with atrial fibrillation, in order to provide clinical basis for diagnosis and treatment. Methods A total of 160 patients who visited several hospitals including Shanghai Xinhua Hospital from June 2019 to June 2021 were selected. Among them, 40 cases were in the drug treatment group (DRUG group), 40 cases in the radiofrequency ablation group (Radiofrequency ablation, RFA group), and 40 cases in the catheter ablation combined with percutaneous left atrial appendage occlusion group (“"one‐stop”" procedure group) and 40 cases in the percutaneous left atrial appendage closure group (Left atrial appendage closure, LAAC group). The Minnesota quality of life score (MLHFQ), ejection fraction (LVEF), and left atrial anterior and posterior diameters (LAD) were compared between the groups at 1‐year follow‐up, and the differences in adverse events were compared between the groups. Results (1) After a 1‐year follow‐up, overall comparison, the MLHFQ scores and the LVEF and the LAD among the four groups were statistically different (p < .01); (2) Multiple comparisons, ① the MLHFQ scores: The RFA group was the lowest, the “one‐stop” operation group was lower than the DRUG group, the LAAC group was the highest (p < .01). ② LVEF: The RFA group was the highest, the “one‐stop” procedure group was higher than the drug treatment group, the LAAC group was the lowest (p < .01). ③ LAD: the RFA group and the “one‐stop” procedure group were smaller than the DRUG group, the DRUG group was smaller than the LAAC group (p < .01).(3) Compared with the baseline data after 1‐year follow‐up in each group, in the RFA group and in the “one‐stop” procedure group, the MLHFQ scores was decreased, the LVEF was increased, and the LAD was decreased (p < .01); in the DRUG group: the difference was not statistically significant (p > .05); in the LAAC group, the MLHFQ scores was increased, the LVEF was decreased, and the LAD was increased (p < .01). (4) There were significant differences in the incidence of adverse events among the four groups (p < .01), the lowest in the RFA group and the highest in the LAAC group. Conclusion Compared with drug treatment, radiofrequency ablation and “one‐stop” procedure group can improve the quality of life of patients with atrial fibrillation, improve cardiac function, and reduce the occurrence of adverse events. Percutaneous left atrial appendage occlusion affects patients' quality of life and improves cardiac function, and increases the incidence of adverse events.

show abstract

Section: Introductionmentioning

confidence: 82%

Effects of different interventions on prognosis and quality of life in patients with atrial fibrillation

Wang

Huang

et al. 2022

Noninvasive Electrocardiol

View full text Add to dashboard Cite

show abstract

“…A one-stop procedure subgroup study from the EWOLUTION and WASP registries showed that Watchman devices were successfully implanted in 99.3% of patients, and PDLs were not detected in 97.2% of patients; during follow-up, 98.2% of patients achieved successful occlusion, and only 2 patients had a PDL > 5 mm due to device displacement ( 14 , 16 ). Chen et al reported a single-center study of the one-stop procedure in which only 0.3% of patients experienced occlusion failure (1,114 patients in total) ( 17 ). There are few reports of PDL follow-up for the CBA one-stop procedure; Fassini et al reported that all 45 patients receiving CBA combined with LAAO had successful implantation, and Ren et al reported that only 1 of 72 patients experienced disc device occlusion failure ( 18 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Left atrial appendage occlusion combined with cryoballoon or radiofrequency ablation: One-year follow-up comparison

Guo

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundA one-stop procedure involving catheter ablation and left atrial appendage occlusion (LAAO) is an option for high-risk atrial fibrillation patients. Few studies have reported the efficacy and safety of cryoballoon ablation (CBA) combined with LAAO, and no studies have compared the combination of LAAO with CBA or radiofrequency ablation (RFA).MethodsA total of 112 patients were enrolled in the present study; 45 patients received CBA combined with LAAO (group 1), and 67 patients received RFA combined with LAAO (group 2). Patient follow-up was performed for 1 year to detect peri-device leaks (PDLs) and safety outcomes (defined as a composite of peri-procedural and follow-up adverse events).ResultsThe number of PDLs at the median 59 days follow-up was comparable between the two groups (33.3% in group 1 vs. 37.3% in group 2, p = 0.693). Safety outcomes were also comparable between the two groups (6.7% in group 1 vs. 7.5% in group 2, p = 1.000). Multivariable regression showed that PDLs risk and safety outcomes were all similar between the two groups. Subgroup analysis of PDLs indicated no significant differences. Follow-up safety outcomes were related to anticoagulant medication, and patients without PDLs were more likely to discontinue antithrombotic therapy. The total procedure and ablation times were all significantly shorter for group 1.ConclusionWhen compared with left atrial appendage occlusion combined with radiofrequency, left atrial appendage occlusion combined with cryoballoon ablation has the same risk of peri-device leaks and safety outcomes, but the procedure time was significantly reduced.

show abstract

“…A propensity score matching analysis from the US National Readmission Database has indicated an annual growth rate of 63% between 2016 and 2019, and no significant difference in MACE and all-cause 30-day readmission rates among patients receiving the combined procedure, matched LAAO only, or catheter ablation only [114]. A retrospective analysis of 1114 patients who underwent the combined procedure in China has supported the safety and long-term efficacy of this modality [115]. Model analysis has suggested that in symptomatic patients with NVAF with high stroke and bleeding risk who plan to undergo catheter ablation, the combined procedure may be a cost-effective therapeutic option particularly beneficial for patients with a CHA2DS2-VASc risk score ≥3 [116].…”

Section: Laao: Current Clinical Statusmentioning

confidence: 99%

Percutaneous Left Atrial Appendage Occlusion Therapy: Past, Present, and Future

Han

Dong

Benditt

2023

CVIA

View full text Add to dashboard Cite

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is increasing in incidence and prevalence worldwide. AF significantly increases the risk of intracardiac thrombus formation and, if left untreated, ischemic stroke. In patients with nonvalvular AF (NVAF), the left atrial appendage (LAA) has been determined to be the source of thrombus development in 91% to 99% of cases. In this regard, oral anticoagulants (OACs) have become the standard treatment for stroke prevention in most patients with AF; however, OACs are associated with a risk of bleeding complications, and their efficacy depends on optimal patient compliance. Among alternative approaches to embolic stroke prevention, surgical LAA excision for stroke prevention for valvular AF was attempted as early as the late 1940s. LAA excision remains recommended in surgical guidelines for patients with NVAF requiring open-heart coronary bypass or valvular replacement/repair surgeries. However, owing to the traumatic/invasive nature and suboptimal outcomes of conventional surgical LAA intervention, clinical application of this approach is limited in current cardiology practice. Percutaneous LAA occlusion (LAAO) is increasingly being performed as an alternative to OAC for stroke prevention, particularly in patients with elevated bleeding risk. Substantial progress has been made in percutaneous LAAO therapy since its inception approximately 20 years ago. This article systematically reviews the literature leading to the development of LAAO and the evidence-based clinical experience supporting the application of this treatment strategy for NVAF, with a focus on recently published critical evaluations of US FDA and CE mark approved LAAO devices. Future perspectives regarding knowledge and technology gaps are also discussed, recognizing the many ongoing clinical trials that are likely to be transformative and the critical unanswered questions regarding LAAO therapy.

show abstract

Long-term outcome of combined catheter ablation and left atrial appendage closure in atrial fibrillation patients

Cited by 14 publications

References 28 publications

Effects of different interventions on prognosis and quality of life in patients with atrial fibrillation

Effects of different interventions on prognosis and quality of life in patients with atrial fibrillation

Left atrial appendage occlusion combined with cryoballoon or radiofrequency ablation: One-year follow-up comparison

Percutaneous Left Atrial Appendage Occlusion Therapy: Past, Present, and Future

Contact Info

Product

Resources

About