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Safety and efficacy of ablation for atrial fibrillation in combination with left atrial appendage occlusion in

Peng-Pai Zhang1, Yan Zhao1, Jian Sun1

  • 1Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.

Clinical Cardiology
|July 31, 2023
PubMed

Insights

Catheter ablation (CA) and left atrial appendage occlusion (LAAO) is a feasible treatment for atrial fibrillation (AF) in octogenarians. This combined procedure shows comparable efficacy and safety to younger patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Geriatric Medicine

Background:

  • Atrial fibrillation (AF) management in octogenarians presents unique challenges.
  • Catheter ablation (CA) combined with left atrial appendage occlusion (LAAO) is an emerging strategy for AF.
  • The efficacy and safety of combined CA and LAAO in patients over 80 years old remain unclear.

Purpose of the Study:

  • To evaluate the feasibility, efficacy, and safety of combined CA and LAAO in octogenarian (≥80 years) AF patients.
  • To compare outcomes in octogenarians versus non-octogenarians undergoing the combined procedure.
  • To assess the potential of this combined approach in restoring sinus rhythm and preventing stroke in elderly AF patients.

Main Methods:

  • A single-center retrospective study included 505 patients undergoing combined CA and LAAO.
  • Patients were divided into octogenarian (≥80 years) and non-octogenarian groups.
  • Efficacy endpoints included procedural success, AF recurrence, and thromboembolic events; safety endpoints included pericardial effusion, device-related thrombus, death, and major bleeding.

Main Results:

  • 46 patients were in the octogenarian group, presenting with higher CHA2DS2VASc scores.
  • AF recurrence rates at follow-up were similar between groups (21.7% vs. 22.4%).
  • The combined procedure demonstrated comparable safety profiles, with low rates of major complications in both groups. Annual thromboembolic risk was 2.1% in octogenarians vs 0.8% in non-octogenarians.

Conclusions:

  • Combined CA and LAAO is a feasible and safe treatment option for octogenarian AF patients.
  • The procedure offers comparable efficacy in terms of AF recurrence and stroke prevention to younger patients.
  • This combined approach provides a viable strategy for managing AF in the elderly population.
Abstract

Keywords:
atrial fibrillationcatheter ablationleft atrial appendage occlusionoctogenarianstroke

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