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Updated: Mar 22, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Combined catheter ablation for atrial fibrillation and Watchman® left atrial appendage occlusion procedures:
Karen P Phillips1, Daniel T Walker1, Julie A Humphries1
1HeartCare Partners, GenesisCare, Greenslopes Private Hospital, Newdegate St, Greenslopes, Brisbane, QLD 4120, Australia.
Insights
Combined catheter ablation for atrial fibrillation (AF) and left atrial appendage (LAA) occlusion offers a safe, two-pronged approach. This strategy achieved high LAA occlusion rates and reduced stroke risk, allowing oral anticoagulant discontinuation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) management requires rhythm control and stroke prevention.
- Concomitant left atrial catheter ablation and left atrial appendage (LAA) occlusion present a dual strategy.
- This study reports outcomes of combined procedures over a 5-year period.
Purpose of the Study:
- To evaluate the feasibility and safety of combined AF catheter ablation and LAA device occlusion.
- To assess the efficacy of this two-pronged strategy for rhythm control and stroke prevention.
- To analyze procedural outcomes, LAA occlusion rates, and long-term clinical events.
Main Methods:
- Ninety-eight patients with non-valvular AF underwent pulmonary vein isolation (PVI) followed by Watchman® LAA device implantation.
- Procedures were performed at a single center over a 5-year timeframe.
- Outcomes included procedural success, LAA occlusion rates, adverse events, and AF recurrence.
Main Results:
- Procedures were uncomplicated with a mean duration of 213±40 minutes.
- Complete LAA occlusion was achieved in 94% initially, reaching 100% at 12 months (86% complete occlusion).
- One ischemic stroke occurred (0.5% per year), and 77% of patients were free from AF at 12 months; oral anticoagulation was discontinued for all patients.
Conclusions:
- Combined AF ablation and LAA occlusion is feasible and safe.
- High rates of LAA occlusion and a low stroke rate were observed.
- Incomplete occlusion correlated with suboptimal device position and lower compression.
Background:
Patients with atrial fibrillation (AF) may benefit from undergoing concomitant interventions of left atrial catheter ablation and device occlusion of the left atrial appendage (LAA) as a two-pronged strategy for rhythm control and stroke prevention. We report on the outcome of combined procedures in a single center case series over a 5-year timeframe.
Methods:
Ninety-eight patients with non-valvular AF and a mean CHA2DS2-VASc score 2.6±1.0 underwent either first time, or redo pulmonary vein isolation (PVI) procedures, followed by successful implant of a Watchman® device.
Results:
All procedures were generally uncomplicated with a mean case time of 213±40 min. Complete LAA occlusion was achieved at initial implant in 92 (94%) patients. Satisfactory LAA occlusion was achieved in 100% of patients at 12 months, with a complete LAA occlusion rate of 86%. All patients discontinued oral anticoagulation. Persistent late peri-device leaks were more frequently associated with device angulation or shoulder protrusion, and were associated with a significantly lower achieved device compression of 12±3% vs. 15±5% (p<0.01) than complete occlusion. One ischemic stroke was recorded over a mean follow-up time of 802±439 days. Twelve months׳ freedom from detectable AF was achieved in 77% of patients.
Conclusions:
Combined procedures of catheter ablation for AF and Watchman® LAA implant appear to be feasible and safe, with excellent rates of LAA occlusion achieved and an observed stroke rate of 0.5% per year during mid-term follow-up. Incomplete occlusion was associated with lower achieved device compression and was more frequently associated with suboptimal device position.
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