Left atrial appendage occlusion and concomitant catheter ablation procedures

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Safety and effectiveness of combined catheter ablation and left atrial appendage occlusion (LAAO) are not well-established.
• Atrial fibrillation (AF) management often involves LAAO and ablation, but their combined use needs further characterization.

Purpose of the Study:

• To compare the safety and effectiveness of LAAO during concomitant AF ablation versus LAAO as a standalone procedure.
• To evaluate outcomes including LAA seal, major adverse events, and long-term composite endpoints.

Main Methods:

• Retrospective analysis of patients from the SURPASS registry.
• Comparison of patients undergoing concomitant ablation and LAAO versus LAAO alone.
• Primary endpoints: complete LAA seal and major adverse events at 45 days.

Main Results:

• Concomitant ablation patients were younger with fewer comorbidities.
• No significant difference in LAA seal at 45 days between groups.
• Higher in-hospital rates of major adverse events, bleeding, and pericardial effusion in the combined group.
• Lower 1-year composite endpoint of mortality, stroke, or systemic embolism in the combined group.

Conclusions:

• Concomitant AF ablation with LAAO is associated with a younger patient profile and fewer comorbidities.
• While peri-device leaks were similar, the combined procedure showed increased in-hospital bleeding and effusion risks.
• Despite initial safety concerns, concomitant AF ablation and LAAO demonstrated a significant reduction in long-term adverse cardiovascular events.