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Updated: Oct 22, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The long-term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and
Feng Li1, Jin-Yu Sun2, Li-Da Wu1
1Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.
Insights
Combined atrial ablation and left atrial appendage closure (LAAC) offers a safe and effective long-term solution for atrial fibrillation patients at high stroke risk. This procedure demonstrates significant benefits in managing arrhythmia and preventing strokes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) poses a significant stroke risk, particularly in patients with specific comorbidities.
- Left atrial appendage closure (LAAC) is an established stroke risk reduction strategy.
- Combined AF ablation and LAAC is emerging as an alternative for high-risk patients, but long-term data are limited.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of combined atrial ablation and LAAC.
- To provide a comprehensive meta-analysis of existing studies on this combined procedural approach.
Main Methods:
- Systematic literature search of PubMed, Embase, Cochrane Library, and Web of Science up to January 1, 2021.
- Inclusion of studies with a mean follow-up of at least 12 months.
- Meta-analysis of pooled data on efficacy (arrhythmia freedom, LAAC sealing) and safety (adverse events, mortality).
Main Results:
- Pooled long-term freedom from atrial arrhythmia was 66% (95% CI: 59-71%).
- LAAC achieved a 100% successful sealing rate (95% CI: 100-100%).
- Long-term incidence of ischemic stroke, TIA, or systemic embolism was low at 1% (95% CI: 0-2%), with minimal periprocedural and long-term adverse events.
Conclusions:
- Combined atrial ablation and LAAC is a safe and effective strategy for managing atrial fibrillation and reducing stroke risk.
- The procedure demonstrates favorable long-term outcomes, including high arrhythmia control and low thromboembolic events.
- This combined approach offers significant long-term benefits for selected high-risk AF patients.
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.
