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[Success rate of one-stop procedure for atrial fibrillation ablation and its impact on cardiac function: a
Shijie Zhu1, Muhan Zheng2, Ruyu Yan1
1Department of Cardiovascular Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Insights
The combination of atrial fibrillation (AF) ablation and left atrial appendage closure (LAAC) is safe and improves cardiac function, but does not enhance AF ablation success rates compared to AF ablation alone. AF ablation alone provides superior cardiac function improvement.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- Atrial fibrillation (AF) is a common arrhythmia requiring treatment.
- Left atrial appendage closure (LAAC) is used to reduce stroke risk in AF patients.
- Combining AF ablation with LAAC offers a potential one-stop solution.
Purpose of the Study:
- To evaluate the safety and efficacy of a combined AF ablation and LAAC procedure.
- To compare cardiac function and AF ablation success rates between the combined procedure and AF ablation alone.
- To assess perioperative complications and thromboembolic events in both groups.
Main Methods:
- Retrospective analysis of 56 patients undergoing combined AF ablation and LAAC.
- Propensity score matching (PSM) to create a control group of 56 patients undergoing AF ablation alone.
- Comparison of perioperative complications, thromboembolic events, arrhythmia recurrence, and cardiac function.
Main Results:
- The combined procedure showed no significant difference in complications or thromboembolic events compared to AF ablation alone.
- The hybrid procedure did not improve the success rate of AF ablation.
- While the combined procedure improved cardiac function (NT-pro BNP, LVEF), AF ablation alone yielded better results.
Conclusions:
- Combined AF ablation and LAAC is a safe approach for AF patients.
- This one-stop procedure does not enhance AF ablation success rates.
- AF ablation alone demonstrates superior improvement in cardiac function compared to the combined approach.
Objective:
To investigate the effect of the combination of atrial fibrillation (AF) ablation and left atrial appendage closure (LAAC) on cardiac function and the success rate of AF ablation.
Methods:
We retrospectively analyzed the data of 56 patients with AF undergoing a one-stop procedure for AF ablation and LAAC in our hospital between May, 2015 and May, 2019. Propensity score matching (PSM) at the ratio of 1:1 was used to select 56 control patients undergoing AF ablation at high risk of stroke, for matching with the hybrid procedure group. The perioperative complications, thromboembolic events, recurrence of atrial arrhythmia and cardiac function were compared between the groups.
Results:
The two groups of patients were comparable for age, gender, BMI, duration and type of AF, concomitant diseases, CHA2DS2-VASc and HAS-BLED scores (P > 0.05). The incidence of complications did not differ significantly between the hybrid procedure group and AF ablation group (17.9% vs 12.5%, P=0.430). Compared with the control patients with AF ablation alone, the patients undergoing the hybrid procedure had a lowered incidence of thromboembolic events, but the difference was not statistically significant (1.8%vs 3.6%, P=1.000). The hybrid procedure did not improve the success rate of AF ablation (OR: 1.338, 95%CI: 0.451-3.973, P= 0.600) but significantly improved the cardiac function parameters including NT-pro BNP (945.3±1401.6 pg/mL vs 1520.7±2089.1 pg/mL, P=0.010), LVEF[(60.8±7.0)% vs (58.6±7.8)%, P=0.044], and left atrial diameter (43.9±7.5 mm vs 45.6±6.3 mm, P=0.076); but the improvement of cardiac function was more obvious in the control patients undergoing AF ablation alone (P < 0.039).
Conclusions:
The combination of AF ablation and LAAC is safe but does not improve the success rate of AF ablation. The one-stop procedure can improve cardiac function of the patients, but AF ablation alone can achieve better improvement of cardiac function.
