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Updated: Sep 10, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Safety and Feasibility of Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion at Centers With Versus
Dinesh Sharma1, Daniel Hanna1, Rachael Venn1
1Division of Cardiology, Rooney Heart Institute at NCH Healthcare System, Naples, Florida, USA.
Insights
Performing atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) without cardiothoracic surgery (CTS) is feasible. These procedures can be safely expanded to centers without onsite CTS when protocols and trained operators are in place.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) traditionally require onsite cardiothoracic surgery (CTS).
- Expanding these procedures to centers without CTS (Wo-CTS) necessitates evaluating safety and feasibility.
Purpose of the Study:
- To compare the safety and feasibility of AF ablation and LAAO at centers with and without onsite CTS.
- Evaluate procedural outcomes within the Naples Comprehensive Healthcare (NCH) System.
Main Methods:
- Retrospective cohort study of consecutive patients (March 2023 - May 2025).
- Collected baseline demographics, clinical characteristics, and procedural complications.
- Analyzed cardiac tamponade, length of stay, and patient demographics using appropriate statistical tests.
Main Results:
- 2458 patients included: 1788 at CTS centers and 670 at Wo-CTS centers.
- AF ablation at Wo-CTS had a 0.5% tamponade rate; CTS had a 0.1% rate (p=0.075).
- LAAO complications at CTS included hemorrhagic stroke and device dislodgement, both managed non-surgically.
Conclusions:
- AF ablation and LAAO are feasible at Wo-CTS centers with established protocols and trained personnel.
- Findings support the expansion of these procedures to centers without onsite CTS.
- Further research is needed to confirm broader applicability.
Background:
Atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) are traditionally performed in centers with onsite cardiothoracic surgery (CTS), expanding these procedures to centers without CTS (Wo-CTS) raises questions about procedural safety and feasibility.
Objective:
To compare the safety and feasibility of AF ablation and LAAO at two centers within the Naples Comprehensive Healthcare (NCH) System in Southwest Florida, one with CTS and the other Wo-CTS.
Methods:
A retrospective cohort study was conducted for consecutive patients between March 1, 2023, to May 31, 2025. Baseline demographics, clinical characteristics, and procedural complications were collected. The cardiac tamponade between the two groups was analyzed using Fisher's exact test, and length of stay (LOS) was analyzed using an independent t-test. Patient demographics were analyzed utilizing a t-test and χ2 test.
Results:
Among 2458 patients (1788 at CTS and 670 at Wo-CTS), baseline comorbidities were similar, except for a higher prevalence of coronary artery disease at CTS. AF ablation patients at Wo-CTS had a 0.5% tamponade rate (3/550), with one requiring surgical repair after transfer. The CTS site had a 0.1% tamponade rate (1/1353, p = 0.075), managed percutaneously. LAAO complications with one hemorrhagic stroke and one device dislodgement at CTS, both managed non-surgically.
Conclusion:
This study supports the feasibility of performing AF ablation and LAAO at Wo-CTS centers under defined protocols and by well-trained operators. Further studies are warranted to confirm broader applicability.
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