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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

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Feasibility of combined therapy: percutaneous left atrial appendage closure and transcatheter edge-to-edge repair

Nobuyuki Fukuda1, Teruhiko Imamura2, Shuhei Tanaka1

  • 1The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.

Cardiovascular Intervention and Therapeutics
|November 28, 2024
PubMed

Insights

Combining left atrial appendage closure (LAAC) with transcatheter edge-to-edge repair (TEER) is a safe and effective strategy for atrial fibrillation patients with mitral regurgitation. This combined approach shows comparable outcomes to LAAC alone, reducing risks of stroke and bleeding.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Atrial fibrillation (AF) patients frequently have concurrent significant mitral regurgitation (MR).
  • Left atrial appendage closure (LAAC) prevents thromboembolism in AF, while transcatheter edge-to-edge repair (TEER) addresses significant MR.
  • The combined efficacy and feasibility of LAAC + TEER are not well-established.

Purpose of the Study:

  • To assess the feasibility and compare outcomes of combined LAAC + TEER versus LAAC alone in patients with AF and MR.
  • To evaluate procedural success, device-related complications, and clinical events at 1-year follow-up.

Main Methods:

  • Retrospective analysis of consecutive patients undergoing LAAC.
  • Comparison of outcomes between a cohort undergoing combined LAAC + TEER (n=11) and LAAC alone (n=181).
  • Assessment of procedural success, device leak, device-related thrombus, thromboembolic events, and bleeding events.

Main Results:

  • High procedural success rates in both groups (100% for combined vs. 99% for LAAC alone).
  • No significant difference in significant device leak (0% vs. 1.1%) or device-related thrombus (0% vs. 6.7%) at 1 year.
  • Comparable cumulative incidence of thromboembolic (p=0.57) and bleeding events (p=0.42) between the groups.

Conclusions:

  • Combined LAAC + TEER is a feasible and effective strategy for carefully selected patients with AF and significant MR.
  • This combined approach demonstrates safety and efficacy comparable to LAAC alone.
  • High-volume, experienced centers are recommended for performing combined LAAC + TEER procedures.

Keywords:
AnticoagulationAtrial fibrillationMitraClipMitral regurgitationWATCHMAN

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