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Updated: Jun 13, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Safety and Outcomes of Concomitant Left Atrial Appendage Occlusion and Atrial Fibrillation Ablation
Khalid Sawalha1, Saeed Abughazaleh1, Ahmad Al Nawaiseh2
1Department of Cardiovascular Medicine, Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts-Baystate, Springfield, Massachusetts, USA.
Insights
Combining atrial fibrillation (AF) ablation with left atrial appendage occlusion (LAAO) is safe. This study found no increased risk of complications like stroke or device issues when performing both procedures together.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Simultaneous catheter ablation for atrial fibrillation (AF) and left atrial appendage occlusion (LAAO) may enhance procedural efficiency and reduce risks.
- However, the safety of combining AF ablation with LAAO requires further investigation due to concerns about potential complications.
Purpose of the Study:
- To compare the safety and outcomes of performing AF ablation concurrently with LAAO versus LAAO alone.
- To evaluate short-term and long-term adverse events associated with the combined procedure.
Main Methods:
- A retrospective cohort study utilized the TriNetX U.S. Collaborative Network.
- Adult patients with AF undergoing LAAO were propensity score matched (1:1) comparing those with same-day AF ablation to those with LAAO alone.
- Key outcomes including mortality, stroke, device leak, and thrombus were assessed up to 1 year.
Main Results:
- After propensity matching, 1,899 patients were analyzed in each group.
- Concomitant AF ablation did not increase the risk of mortality, stroke, device leak, or device-related thrombus at 90 days or 1 year.
- All-cause mortality rates were similar between the groups at both 90 days and 1 year.
Conclusions:
- Performing AF ablation concurrently with LAAO is a safe strategy.
- The combined approach does not elevate the risk of early or 1-year complications in appropriately selected patients.
- This supports the feasibility of a combined AF ablation and LAAO procedure.
Background:
Performing atrial fibrillation (AF) catheter ablation and percutaneous left atrial appendage occlusion (LAAO) during a single procedure may improve efficiency and reduce cumulative procedural risk. However, concerns remain regarding potential increases in periprocedural and longer-term complications, including stroke, pericardial effusion, device leak, and device-related thrombus. Evidence evaluating the safety of this concomitant strategy remains limited.
Objectives:
The objectives of the study was to compare the safety and short- and long-term outcomes of concomitant AF ablation plus LAAO vs LAAO alone.
Methods:
We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network, identifying adults (≥18 years) with AF who underwent percutaneous LAAO between January 2015 and February 2026. Patients undergoing AF ablation on the same day as LAAO were compared with those undergoing LAAO alone. After 1:1 propensity score matching for demographics, comorbidities, cardiovascular medications, and laboratory values, 1,899 patients were included in each group. Outcomes including all-cause mortality, stroke, device leak, device-related thrombus, pericardial effusion, and pericardiocentesis were assessed at 7 days, 90 days, and 1 year using cumulative incidence and Cox proportional hazards models.
Results:
Baseline characteristics were well balanced after matching. Concomitant AF ablation was not associated with increased adverse events. Mortality was similar at 90 days (0.6% vs 0.6%; HR: 1.00; 95% CI: 0.43-2.32) and 1 year (1.4% vs 1.5%; HR: 0.97; 95% CI: 0.58-1.63). At 90 days, rates of stroke, device leak, and device-related thrombus were comparable between groups, with no differences observed at 1 year.
Conclusions:
In this large, propensity-matched analysis, concomitant AF ablation at the time of LAAO was not associated with increased early or 1-year complications, supporting the safety of a combined approach in appropriately selected patients.
