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Updated: May 7, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Closure With Catheter Ablation vs. Ablation Alone on Outcomes of Atrial Fibrillation in Heart
Fidelis E Uwumiro1, Oghenemaro O Oghotuoma2, Nathaniel Eyiah3
1Internal Medicine, Prime Healthcare-SRGA, Riverdale, USA.
Insights
Combining left atrial appendage closure with catheter ablation (LAACCA) for atrial fibrillation in heart failure patients was linked to increased mortality and costs compared to catheter ablation alone. Further research is needed to understand these outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Atrial fibrillation (AFib) and heart failure with reduced ejection fraction (HFrEF) often coexist, increasing stroke risk and mortality.
- Left atrial appendage closure with catheter ablation (LAACCA) aims to manage both AFib and stroke risk simultaneously.
- The comparative in-hospital outcomes of LAACCA versus catheter ablation (CA) alone in HFrEF patients remain under investigation.
Purpose of the Study:
- To compare the in-hospital outcomes of LAACCA versus CA alone in patients with HFrEF and AFib.
- To evaluate differences in mortality, hospital stay duration, hospitalization costs, and complication rates between the two procedures.
Main Methods:
- Analysis of adult hospitalizations for HFrEF and AFib from the 2016-2020 Nationwide Inpatient Sample.
- Utilized validated ICD-10 codes to identify patients undergoing LAACCA or CA alone.
- Employed propensity score matching to control for patient, hospital, and procedural covariates, ensuring balanced comparison groups.
Main Results:
- The propensity score-matched cohort included 18,195 LAACCA cases and 18,195 CA cases.
- LAACCA was associated with significantly higher rates of prolonged hospital stay (7.6 vs 5.6 days), mortality (1.1% vs 0.9%), and hospitalization costs ($289,960 vs $183,932) compared to CA alone.
- LAACCA showed increased incidence of acute myocardial ischemia, atrioventricular block, pneumothorax, hemothorax, pneumonia, and septicemia, while CA alone had higher rates of cardiac tamponade and femoral artery pseudoaneurysm.
Conclusions:
- In HFrEF patients with AFib, LAACCA is associated with increased in-hospital mortality, prolonged hospital stays, and higher costs compared to CA alone.
- LAACCA also demonstrated a higher incidence of several serious post-procedural complications.
- These findings suggest a need for careful consideration of risks and benefits when selecting between LAACCA and CA alone for this patient population.
Abstract:
Background Combining left atrial appendage closure with catheter ablation (LAACCA) has been proposed as a potential approach to improving outcomes by simultaneously addressing arrhythmia and reducing stroke risk. This study compares the in-hospital outcomes of LAACCA vs. catheter ablation (CA) alone for atrial fibrillation (AFib) in patients with heart failure with reduced ejection fraction (HFrEF). Methods We analyzed adult hospitalizations with HFrEF and AFib who underwent LAACCA or CA alone from the 2016-2020 nationwide inpatient sample using validated ICD-10 codes. Propensity score matching, accounting for patient-, hospital-, and procedure-level covariates, illness severity, and baseline risk of mortality, was used to alleviate bias in nonrandomized treatment assignments. The primary endpoints included all-cause in-hospital mortality, hospital stay, and hospitalization costs. Secondary endpoints included postprocedural complication rates. Prolonged hospitalization was defined as hospital stay in the top decile of hospital stay in each cohort. All statistical analyses in the study were based on weighted hospital data. Results About 233,865 HFrEF patients were hospitalized for AFib. Approximately 27,945 (11.9%) underwent LAACCA, while 205,920 (88.1%) underwent CA only. The cohort comprised mostly males (151,077; 64.6%) (mean age: 67.4; SD: 4.3). The propensity score-matched cohort comprised 18,195 LAACCAs and 18,195 CAs; all covariate imbalances were alleviated. LAACCA was associated with a higher rate of prolonged hospital stay (7.6 vs 5.6 days; P<0.001), a higher mortality rate (209 (1.1%) vs. 160 (0.9%); P=0.011), and higher mean hospital costs ($289,960 vs. $183,932; P<0.001) compared with CA alone. LAACCA was associated with a higher incidence of acute myocardial ischemia (528 (2.9%) vs. 455 (2.5%); P=0.013), complete atrioventricular block (1,200 (6.6%) vs. 892 (4.9%); P=0.004), need for implantable device therapy (1,510 (8.3%) vs. 1,348 (7.4%); P=0.017), pneumothorax (328 (1.8%) vs. 91 (0.5%); P<0.0001), hemothorax (200 (1.1%) vs. 127 (0.7%); P<0.0001), pneumonia (983 (5.4%) vs. 546 (3.0%); P<0.0001), vascular access complications (346 (1.9%) vs. 255 (1.4%); P=0.046), and septicemia (309 (1.7%) vs. 182 (1.0%); P<0.001). CA was associated with a greater incidence of cardiac tamponade (237 (1.3%) vs. 382 (2.1%); P=0.010) and femoral artery pseudoaneurysm (364 (0.2%) vs. 91 (0.5%); P<0.001). Conclusion LAACCA was correlated with higher mortality odds compared to CA alone for atrial fibrillation in HFrEF.
