Long-term outcomes of left atrial appendage closure with or without concomitant pulmonary vein isolation:a propensity score matching analysis based on CLACBAC study

Xiang Li ^1,2,3, Shiyu Feng ¹, Zhongyuan Ren ^1,2

¹Tongji University School of Medicine, Shanghai, 200092, China.
²Heart Centre, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
³Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200092, China.
⁴School of Medicine, Anhui University of Science and Technology, Anhui province, Huainan, China.
⁵School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
⁶Department of Cardiology, Shanghai Tenth People's Hospital Chongming Branch, Shanghai, 202157, China.
⁷Tongji University School of Medicine, Shanghai, 200092, China. xuyawei@tongji.edu.cn.
⁸Heart Centre, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China. xuyawei@tongji.edu.cn.
⁹Tongji University School of Medicine, Shanghai, 200092, China. zhaodd@tongji.edu.cn.
¹⁰Heart Centre, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China. zhaodd@tongji.edu.cn.
¹¹Tongji University School of Medicine, Shanghai, 200092, China. yinxiaobing@hotmail.com.
¹²Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200092, China. yinxiaobing@hotmail.com.

⁰Tongji University School of Medicine, Shanghai, 200092, China.

Bmc Cardiovascular Disorders +

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February 3, 2024

View abstract on PubMed

Summary

Combining left atrial appendage closure (LAAC) with pulmonary vein isolation (PVI) did not increase complications or reduce thrombotic events compared to LAAC alone. However, the combined procedure showed improved heart function, indicating potential long-term benefits.

Area Of Science

Cardiology
Interventional Cardiology
Electrophysiology

Background

Left atrial appendage closure (LAAC) combined with pulmonary vein isolation (PVI) is effective and safe.
Long-term comparative data for combined LAAC and PVI versus LAAC alone is limited.
This study compares long-term outcomes of combined LAAC-PVI versus LAAC alone.

Purpose Of The Study

To assess long-term outcomes of combined LAAC and PVI versus LAAC alone.
To compare clinical events including thrombotic events, MACCE, re-hospitalization, and atrial tachycardia.
To evaluate bleeding events, peri-device complications, and AF recurrence rates.

Main Methods

Propensity score matching (PSM) used to create comparable groups from 333 non-valvular atrial fibrillation patients.
153 patients included post-PSM: 102 in combined LAAC-PVI group, 51 in LAAC alone group.
Clinical outcomes, bleeding, and peri-device complications were compared; a PVI alone group was included for AF recurrence analysis.

Main Results

No significant baseline differences between groups post-PSM.
Mean follow-up was 37.6 months.
Comparable rates of thrombotic events, MACCE, CVD re-hospitalization, atrial tachycardia, bleeding, and peri-device complications between groups.
Combined procedure group showed improved left ventricular ejection fraction (LVEF) at 12 months (60.5% vs. 57.2%, p=0.002).

Conclusions

Combined LAAC and PVI did not increase complications or offer significant advantages in preventing thrombotic/cardiovascular events compared to LAAC alone.
The combined procedure demonstrated improved heart function, suggesting potential long-term cardiac benefits.
Further research may clarify the specific long-term advantages of concomitant PVI in LAAC procedures.

Keywords:

Atrial fibrillation Left atrial appendage closure Long-term benefits Propensity matching study Pulmonary vein ablation