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Updated: Sep 21, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Periprocedural Outcomes Associated With Use of a Left Atrial Appendage Occlusion Device in China
Fangju Su1,2, Chao Gao1, Jianzheng Liu1
1Department of Cardiology, Xijing Hospital, Xi'an, China.
Insights
Left atrial appendage occlusion (LAAO) is effective for atrial fibrillation patients in China, showing high procedural success and low adverse events. This study confirms LAAO
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Left atrial appendage occlusion (LAAO) offers an alternative to anticoagulation for atrial fibrillation (AF) patients.
- The efficacy and safety of LAAO in East Asian populations, specifically in China, were previously undocumented.
Purpose of the Study:
- To evaluate the procedural success rate and safety of LAAO in Chinese patients with AF.
- To document major adverse event rates and antithrombotic medication strategies post-LAAO.
Main Methods:
- A prospective cohort study involving 3096 consecutive patients from 39 Chinese centers undergoing LAAO.
- Data collected on periprocedural techniques, intraprocedural imaging, and postprocedural medications.
- Analysis of procedural success, 30-day major adverse events (death, stroke, systemic embolism, bleeding), and logistic regression for technique associations.
Main Results:
- High procedural success rate of 97.9% was achieved in 3096 patients.
- Low 30-day composite endpoint rate (death, stroke, systemic embolism) of 0.52% and major bleeding rate of 1.23%.
- Higher procedural success and lower bleeding risk were associated with centers performing ≥40 procedures/year.
Conclusions:
- LAAO implantation in Chinese patients with high stroke and moderate-to-high bleeding risk demonstrates high procedural success.
- Short-term ischemic and bleeding events following LAAO in this cohort were low.
- Center volume appears to be a significant factor influencing procedural success and safety outcomes.
Importance:
Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation for patients with atrial fibrillation. However, the performance of LAAO among East Asian patients is unknown.
Objective:
To document the procedural success rate and configurations, major adverse event rates, and antithrombotic medication regimens during and after LAAO procedures among patients in China.
Design, Setting, And Participants:
In this cohort study, consecutive patients from 39 Chinese centers undergoing LAAO were prospectively enrolled between April 1, 2019, and October 31, 2020. Periprocedural and intraprocedural techniques and postprocedural medications were left to the surgeon's discretion. Data were analyzed from July 1 to November 1, 2021.
Exposure:
LAAO for patients with atrial fibrillation.
Main Outcomes And Measures:
The main outcomes were procedural success and complication rates periprocedure and major adverse event rates of death, stroke, systemic embolism, and bleeding events at 30 days postprocedure; the composite end point of death, stroke, and systemic embolism was also analyzed. Unadjusted and multivariable-adjusted logistic regression analyses were performed to assess the associations of periprocedural techniques (types of anesthesia, intraprocedural imaging modalities, and combined ablation procedure) with 30-day adverse events.
Results:
Among 3096 enrolled participants, 1782 participants (57.6%) were men, and the mean (SD) age was 69 (9) years. Participants had a high risk of stroke (mean [SD] cardiovascular risk score, 4.0 [1.8]) and a moderate-to-high risk of bleeding (mean [SD] bleeding risk score, 2.4 [1.2]). A total of 1287 procedures (41.6%) were performed under local anesthesia, while 493 procedures (15.9%) used only fluoroscopy guidance. In 1297 procedures (41.9%), LAAO implantation was combined with radiofrequency ablation or cryoablation for atrial fibrillation. Procedural success was achieved in 3032 patients (97.9%). At 30-day follow-up, the rate of the composite end point of death, stroke, or systemic embolism was 0.52% (95% CI, 0.32%-0.84%), and the rate of any life-threatening or major bleeding was 1.23% (95% CI, 0.90%-1.68%). No significant associations were observed between the procedural success or 30-day adverse events and the types of anesthesia (general or local), intraprocedural imaging (transesophageal echocardiography, fluoroscopy, or intracardiac echocardiography), or whether a combined ablation procedure was performed or not. In centers performing at least 40 procedures per year, compared with those performing fewer than 40 procedures per year, procedural success was significantly higher (adjusted odd ratio [aOR], 1.97; 95% CI, 1.01-3.53; P = .02) and risk of life-threatening or major bleeding was significantly lower (aOR, 0.42; 95% CI, 0.21-0.87; P = .02).
Conclusions And Relevance:
These findings suggest that patients with a high risk of stroke and moderate to high risk of bleeding who underwent implantation of a LAAO device in Chinese centers had high rates of procedural success and low rates of short-term ischemic and bleeding events.
