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Updated: Sep 20, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Safety and Efficacy of Left Atrial Catheter Ablation in Patients with Left Atrial Appendage Occlusion Devices
Binhao Wang1, Bin He1, Guohua Fu1
1Arrhythmia Center, Ningbo First Hospital, Ningbo 315000, China.
Insights
Left atrial appendage occlusion (LAAO) followed by catheter ablation (CA) is safe for atrial fibrillation patients. This study found LA CA effective in patients with LAAO devices, with no major complications or device issues.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulation for preventing thromboembolism in atrial fibrillation (AF).
- The safety and efficacy of left atrial (LA) catheter ablation (CA) in patients already implanted with LAAO devices remain under-investigated.
- This study focuses on patients with nitinol cage or plug LAAO devices undergoing LA CA.
Purpose of the Study:
- To evaluate the safety and efficacy of left atrial catheter ablation (LA CA) in patients with pre-existing left atrial appendage occlusion (LAAO) devices.
- To assess periprocedural outcomes and long-term efficacy of LA CA in this specific patient population.
- To determine the incidence of adverse events, device-related complications, and arrhythmia recurrence after LA CA in LAAO patients.
Main Methods:
- Eighteen patients with LAAO devices (10 nitinol cage, 8 nitinol plug) and symptomatic left atrial tachyarrhythmias underwent 20 LA CA procedures.
- Procedures included pulmonary vein isolation, linear ablation, and complex fractionated atrial electrogram ablation.
- Periprocedural and follow-up data, including echocardiography and clinical outcomes, were assessed.
Main Results:
- No major adverse events occurred during the 20 LA CA procedures.
- Transesophageal echocardiography revealed no device-related thrombus, peridevice leakage, or dislodgement.
- At a median follow-up of 793 days, 22% of patients experienced arrhythmia recurrence, with no stroke or major bleeding events.
Conclusions:
- Left atrial catheter ablation appears to be a safe and effective procedure in patients with nitinol cage or nitinol plug LAAO devices.
- The findings suggest that LA CA can be considered in patients with AF and LAAO devices experiencing refractory tachyarrhythmias.
- Further research with larger cohorts is warranted to confirm these single-center findings.
Background:
Left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulation for thromboembolic prevention in patients with atrial fibrillation (AF). Left atrial (LA) catheter ablation (CA) in patients with LAAO devices has not been well investigated. Here, we report on the safety and efficacy of LA CA in patients with nitinol cage or plug LAAO devices.
Methods:
A total of 18 patients (aged 67 ± 11 years; 14 males; 5 paroxysmal AF) with LAAO devices (nitinol cage, n = 10; nitinol plug, n = 8) and symptomatic LA tachyarrhythmias were included. Periprocedural and follow-up data were assessed.
Results:
A total of 20 LA CA procedures were performed at a median of 130 (63, 338) days after LAAO. The strategy of CA consisted of circumferential pulmonary vein isolation (n = 16), linear lesions (n = 14) and complex fractionated atrial electrogram ablation (n = 6). No major adverse events occurred periprocedurally. Repeated transesophageal echocardiography showed no device-related thrombus, newly developed peridevice leakage or device dislodgement. After a median follow-up period of 793 (376, 1090) days, four patients (22%) experienced LA tachyarrhythmias recurrence and two received redo LA CA. No patients suffered stroke or major bleeding events during follow-up.
Conclusions:
LA CA in patients with LAAO devices (either nitinol cages or nitinol plugs) seems to be safe and efficient in our single-center experience.
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