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Updated: Nov 20, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Improved outcomes in CABG patients with atrial fibrillation associated with surgical left atrial appendage exclusion
Edward G Soltesz1, Krish C Dewan1, Louise H Anderson2
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
Left atrial appendage clip exclusion (LAACE) during coronary artery bypass grafting (CABG) in patients with atrial fibrillation (AF) significantly reduces long-term mortality and thromboembolic events. This procedure also lowers readmission rates without increasing operative risk.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Atrial fibrillation (AF) is a common comorbidity in patients undergoing coronary artery bypass grafting (CABG).
- Left atrial appendage (LAA) is a primary source of thrombus formation in AF patients, posing a risk for thromboembolic events post-CABG.
- The impact of concomitant LAA exclusion during CABG on patient outcomes remains an area of investigation.
Purpose of the Study:
- To evaluate the effect of left atrial appendage clip exclusion (LAACE) on short- and long-term outcomes in patients with pre-existing AF undergoing isolated CABG.
- To assess the risks of thromboembolism and mortality associated with LAACE during CABG.
- To determine the impact of LAACE on hospital readmissions and healthcare costs post-CABG.
Main Methods:
- A retrospective analysis of 4210 Medicare beneficiaries with pre-existing AF undergoing isolated CABG between October 2015 and October 2017.
- Patients were divided into two groups: those who underwent CABG with LAACE (n=931) and those who underwent isolated CABG without LAACE (n=3279).
- Inverse probability of treatment weighting (IPTW) was employed to adjust for baseline differences, followed by competing-risk regression and Cox proportional hazard models to assess outcomes.
Main Results:
- No significant differences were observed in operative mortality, length of stay, or 30-day readmission rates between the groups.
- The CABG + LAACE group demonstrated a 26% lower risk of thromboembolism over 2 years (sHR=0.74, p=0.049) and a 45% lower risk of all-cause mortality during late follow-up (HR=0.55, p=0.031).
- The CABG + LAACE group experienced significantly lower readmission rates (31% vs. 43%, p<0.001) and fewer total inpatient days during follow-up, with similar total healthcare costs through one year.
Conclusions:
- Concomitant left atrial appendage exclusion using an epicardial closure device is associated with improved long-term outcomes in patients with AF undergoing CABG.
- LAACE during CABG is linked to reduced mortality, fewer thromboembolic events, and decreased hospital readmissions.
- The findings suggest LAACE is a safe and effective adjunct to CABG in patients with AF, improving overall patient prognosis.
Background:
We sought to determine the impact of left atrial appendage clip exclusion (LAACE) on coronary artery bypass grafting (CABG) outcomes among patients with pre-existing atrial fibrillation (AF).
Methods:
From October 1, 2015 to October 1, 2017, 4210 Medicare beneficiaries with pre-existing AF underwent isolated CABG (i.e., without ablation) with (n = 931) or without (n = 3279) LAACE. Inverse probability of treatment weighting was used to evaluate the effect of concomitant LAACE on short- and long-term outcomes after CABG. Long term risks of thromboembolism and mortality were assessed using competing-risk regression and Cox proportional hazard models.
Results:
Operative mortality, length of stay, and 30-day readmission did not differ between groups. Thromboembolism risk was 26% lower for the CABG + LAACE group compared with isolated CABG over a 2-year time-to-event analysis (sub hazard ratio [sHR] 0.74, 95% confidence interval [CI] 0.54-1.00, p = .049). There were no differences in ischemic stroke rates. All-cause mortality risk was 45% lower for CABG + LAACE during the late follow-up period (91-730 days; HR 0.55, 95% CI 0.32-0.95, p = .031). The late period annual absolute all-cause mortality rate was 3.7% for CABG + LAACE and 6.9% for isolated CABG. There were lower readmission rates (31% vs. 43%, p < .001) and total inpatient days (4.0 days vs. 7.2 days, p < .01.) for the CABG + LAACE during follow-up. Total hospital in and out-patient treatment costs were similar between groups through one year.
Conclusions:
Concomitant LAA exclusion via an epicardial closure device is associated with reduced CABG mortality, thromboembolic events, and readmissions in patients with pre-existing atrial fibrillation.
