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Updated: Jun 6, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Outcomes of Concomitant Atrial Fibrillation Ablation and Left Atrial Appendage Closure: A Retrospective Single-Center
Ashraf Alzahrani1, Oussama M Wazni2, Ayman Hussein2
1Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Insights
Combining catheter ablation for atrial fibrillation (AF) with left atrial appendage closure (LAAC) is a safe and effective strategy. This combined procedure reduces stroke risk and bleeding events in AF patients needing anticoagulation alternatives.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Catheter ablation effectively manages atrial fibrillation (AF).
- Left atrial appendage closure (LAAC) offers an alternative to anticoagulation for stroke prevention in patients with high bleeding risk.
- Combining these procedures may offer a comprehensive solution for select AF patients.
Purpose of the Study:
- To evaluate the safety and efficacy of performing AF ablation and LAAC concurrently.
- To assess procedural success rates, complication profiles, and long-term outcomes of the combined approach.
Main Methods:
- A retrospective observational study of 178 patients undergoing combined AF ablation and LAAC from June 2015 to August 2021.
- Assessment of procedural success, periprocedural complications, thromboembolism, bleeding events, and arrhythmia recurrence.
- Evaluation of LAAC device closure efficacy and incidence of device-related thrombus.
Main Results:
- Pulmonary vein isolation was achieved in all patients; LAAC success rate was 91.6%.
- The periprocedural complication rate was 6.2%. Over a median follow-up of 412 days, the annual stroke/TIA risk was 1.7% at 1 year and 4.6% at 2 years.
- Complete LAAC seal was achieved in 97.5% intraprocedurally and 73.7% on follow-up, with 1.3% device-related thrombus. Bleeding events occurred in 17.4% of patients, and anticoagulation was discontinued in 93.8%.
Conclusions:
- Concomitant AF ablation and LAAC is a viable option for appropriate patients.
- This combined strategy can be safely performed in experienced centers.
- The procedure demonstrates good efficacy in stroke risk reduction and allows for discontinuation of anticoagulation in many patients.
Background:
Catheter ablation is an effective therapy in the management of atrial fibrillation (AF). Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention in patients with bleeding risks.
Objectives:
The purpose of this study was to assess the safety and efficacy of combining AF ablation and LAAC in a single procedure.
Methods:
This retrospective observational study included consecutive patients who underwent concomitant AF ablation and LAAC between June 2015 and August 2021. We assessed the safety and efficacy of the combined procedure with respect to procedural success, periprocedural complications, thromboembolism, bleeding, and arrhythmia recurrence.
Results:
A total of 178 patients (mean age 72.1 ± 8.7 years, 60.7% male) were identified. The mean CHA2DS2VASc and HAS-BLED scores were 4.0 ± 1.4 and 2.8 ± 1.1, respectively. Pulmonary vein isolation was achieved in all patients. LAAC was aborted in 15 cases (success rate of 91.6%). The periprocedural complications rate was 6.2%. The median follow-up duration was 412 days IQR: 213 to 781 days. There were 2 strokes and 3 transient ischemic attacks, equating to an annual risk of 1.7% at 1 year and 4.6% at 2 years. Complete seal was achieved in 97.5% intraprocedurally and in 73.7% on initial follow-up, with no major leaks identified. There were 2 cases (1.3%) of device-related thrombus that resolved with anticoagulation. Thirty-four bleeding events occurred in 28 patients (17.4%). Anticoagulation was discontinued in 93.8% of patients.
Conclusions:
Concomitant AF ablation and LAAC could be considered in appropriate patients in centers of clinical expertise.
