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Updated: Aug 26, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage closure in nonvalvular atrial fibrillation patients with percutaneous coronary intervention
Yunan Yu1, Jing Xu2, Liang Wang2
1Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Insights
Left atrial appendage closure (LAAC) is a safe and effective stroke prevention method for patients with nonvalvular atrial fibrillation (NVAF) who have undergone percutaneous coronary intervention (PCI). This procedure demonstrates comparable safety and efficacy to standard treatments.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Management
Background:
- Nonvalvular atrial fibrillation (NVAF) combined with coronary artery disease (CAD) increases thromboembolic risk.
- Antithrombotic therapy in NVAF patients post-percutaneous coronary intervention (PCI) presents challenges.
- Left atrial appendage closure (LAAC) is an emerging alternative for stroke prevention.
Purpose of the Study:
- To evaluate the safety and efficacy of LAAC in NVAF patients with a history of PCI.
- To compare outcomes between NVAF patients with and without PCI undergoing LAAC.
Main Methods:
- Retrospective analysis of 109 patients undergoing LAAC (March 2017-December 2020).
- Patients divided into Group I (with PCI, n=36) and Group II (without PCI, n=73).
- Analysis of peri-procedural, long-term complications, ischemia, and bleeding events.
Main Results:
- Group I had higher rates of diabetes, CHA2DS2-VASc, and HAS-BLED scores.
- No significant differences in 7-day procedure-related complications between groups.
- Similar long-term rates of cardiovascular death, stroke/TIA, major bleeding, and device-related thrombus.
- Kaplan-Meier analysis showed significant reductions in annualized thromboembolic and bleeding events in both groups post-LAAC.
Conclusions:
- LAAC is a safe and effective strategy for stroke prevention in NVAF patients who have undergone PCI.
- The procedure offers comparable outcomes to those without a PCI history.
- LAAC provides a viable alternative for managing thromboembolic risk in this complex patient population.
Objectives:
Nonvalvular atrial fibrillation (NVAF) concomitant with coronary artery disease (CAD) may increase the risk of thromboembolism. Antithrombotic therapy for NVAF patients with percutaneous coronary intervention (PCI) remains contradictory and challenging. This study aimed to assess the safety and efficacy of left atrial appendage closure (LAAC) in a cohort of patients with NVAF and PCI.
Methods:
A total of 109 patients undergoing LAAC procedures between March 2017 and December 2020 were categorized into 2 groups, Group I included 36 patients with PCI while group II included 73 patients without. Peri-procedural and long-term complications, as well as ischemia and bleeding events, were retrospectively analyzed.
Results:
Group I had more diabetes mellitus (55.6% vs. 26.0%; p = 0.003), higher CHA2DS2-VASc scores (5.44 ± 1.85 vs. 4.22 ± 1.64; p = 0.002) and HAS-BLED scores (3.39 ± 0.93 vs. 2.74 ± 1.05; p = 0.003) compared to Group II. Procedure-related complications within 7 days were similar in both groups (8.3% vs. 8.2%; P = 1.000). Over a median follow-up period of 20.9 months, there were no significant differences between two subgroups with regard to cardiovascular death (2.8% vs. 0%, p = 0.330), stroke/transient ischemic attack (2.8% vs. 5.5%, p = 1.000), major bleeding (0% vs. 2.7%, p = 1.000) and device-related thrombus (8.3% vs. 1.4%, p = 0.104). The observed annualized thromboembolic and major bleeding events determined by Kaplan-Meier analysis decreased by 82.4% and 100% in group I, 55.9% and 75.8% in group II, respectively.
Conclusion:
LAAC is a safe and effective option for stroke prevention in NVAF patients with PCI.
