Comparison of Adverse Events between Isolated Left Atrial Appendage Closure and Combined Catheter Ablation

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Atrial fibrillation (AF) management often involves anticoagulation and rhythm control strategies.
• Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation for stroke prevention in AF.
• Catheter ablation (CA) is used to restore sinus rhythm in AF patients.

Purpose of the Study:

• To evaluate the safety and efficacy of combining catheter ablation (CA) with left atrial appendage closure (LAAC).
• To assess the impact of the combined CA + LAAC procedure on post-procedural adverse events compared to LAAC alone.

Main Methods:

• Retrospective analysis of 361 patients with atrial fibrillation who underwent LAAC between July 2017 and February 2022.
• Comparison of adverse events, including device-related thrombus (DRT) and embolic events, between the CA + LAAC group and the LAAC-only group.
• Logistic and Cox regression analyses were performed to identify risk factors and protective factors for adverse events.

Main Results:

• The CA + LAAC group showed significantly lower incidence of device-related thrombus (DRT) (p=0.01) and embolic events (p=0.04) compared to the LAAC-only group.
• Combined procedure was a protective factor for DRT (OR=0.09, p=0.04) and embolism (HR=0.25, p=0.03).
• Older age (≥65 years) was marginally associated with an increased risk of embolism (HR=7.49, p=0.07).

Conclusions:

• The combined CA + LAAC procedure may reduce the risk of post-procedural DRT and embolization without increasing other adverse events.
• The combined approach demonstrates potential as a safe and effective strategy for selected AF patients.
• A validated risk-prediction model was developed for the combined procedure.