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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Combining catheter ablation and left atrial appendage occlusion in high-risk patients with atrial fibrillation: a

Ziyong Hao1, Bin Liu1, Xiaoyi Xie2

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

Hellenic Journal of Cardiology : HJC = Hellenike Kardiologike Epitheorese
|March 9, 2024
PubMed

Insights

Combining catheter ablation (CA) with left atrial appendage occlusion (LAAO) is safe for atrial fibrillation (AF) patients. This approach may reduce heart failure hospitalizations, though it increases peri-device leaks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrophysiology

Background:

  • The combined safety and efficacy of catheter ablation (CA) and left atrial appendage occlusion (LAAO) versus LAAO alone for atrial fibrillation (AF) patients is not well-established.
  • Patients with AF and increased stroke risk undergoing LAAO were evaluated.

Purpose of the Study:

  • To compare the safety and efficacy of a combined CA and LAAO approach versus LAAO alone in AF patients.
  • To assess a composite endpoint including death, thromboembolic events, major bleeding, heart failure (HF) rehospitalization, and periprocedural complications.

Main Methods:

  • A total of 707 AF patients undergoing LAAO were analyzed.
  • Propensity score matching created two groups: LAAO alone (83 patients) and combined CA and LAAO (83 patients).
  • The primary endpoint was a composite of death, thromboembolic events, major bleeding, HF rehospitalization, and major periprocedural complications, with a median follow-up of 2 years.

Main Results:

  • Successful LAAO was achieved in all patients, with similar low periprocedural complication rates (2.4% vs. 4.8%).
  • Peri-device leak was significantly higher in the combined group (25.3% vs. 43.4%, p=0.01).
  • No significant difference was observed in the primary composite endpoint between groups (22.2% vs. 14.3%, p=0.63), but HF rehospitalization was significantly lower in the combined group (19.6% vs. 3.6%, p=0.024).

Conclusions:

  • A combined CA and LAAO "one-stop" approach is safe for AF patients.
  • This combined strategy offers additional benefits in reducing heart failure symptoms and hospitalizations.
  • Increased incidence of peri-device leak is a consideration when combining CA and LAAO.
Abstract

Keywords:
Atrial fibrillationCatheter ablationHeart failureLeft atrial appendage occlusionPeri-device leak

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