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

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Direct current cardioversion of atrial fibrillation in patients with left atrial appendage occlusion devices

Xin Xie1, Zijun Chen1, Xiaorong Li1

  • 1Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.

Frontiers in Cardiovascular Medicine
|November 21, 2025
PubMed

Insights

Direct current cardioversion (DCCV) is safe and effective in patients with left atrial appendage occlusion (LAAO) devices. This study found no increased risk of adverse events or thromboembolism in patients undergoing DCCV after LAAO device implantation.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Limited data exists on the safety and efficacy of direct current cardioversion (DCCV) in patients with left atrial appendage occlusion (LAAO) devices.
  • Understanding the impact of DCCV on thromboembolic prevention in this population is crucial for clinical decision-making.

Purpose of the Study:

  • To investigate the safety and efficacy of DCCV in patients who have undergone LAAO procedures.
  • To assess DCCV-related risks and its impact on thromboembolic events in patients with LAAO devices.

Main Methods:

  • An ambispective cohort study included 196 patients undergoing LAAO, with 95 receiving DCCV post-procedure.
  • Safety endpoints included DCCV-related death, device dislodgement/embolization, and major bleeding.
  • Efficacy endpoints comprised all-cause death, cardiovascular death, stroke/transient ischemic attack, and systemic embolism.

Main Results:

  • No DCCV-related deaths, device dislodgements, or embolizations occurred.
  • Safety endpoints (3.2% vs. 6.9%) and efficacy endpoints (1.1% vs. 4.0%) showed no significant difference between DCCV and no-DCCV groups at 12 months.
  • Transesophageal echocardiography revealed minor, non-adverse changes in device diameter post-DCCV.

Conclusions:

  • Direct current cardioversion (DCCV) can be safely performed in patients with left atrial appendage occlusion (LAAO) devices.
  • No increased risk of adverse events or thromboembolic complications was observed.
  • Minor device diameter changes noted on TEE were not associated with adverse outcomes.
Abstract

Keywords:
atrial fibrillationdirect current cardioversionleft atrial appendage occlusionone-stop procedureradiofrequency ablation

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