The Efficacy of Left Atrial Appendage Occlusion During Thoracoscopic Epicardial AF Ablation for Improving Rhythm and...

The left atrial appendage represents the main source of thrombus formation in patients with atrial fibrillation (AF). The LAA plays an important role in LA reservoir function, especially in patients with heart failure (HF). Limited data are available regarding the efficacy of surgical left atrial appendage occlusion (LAAO) during thoracoscopic epicardial AF ablation for improving rhythm and cardiac function.

Patients who underwent thoracoscopic epicardial AF ablation with or without LAAO for AF combined with HF from February 2012 to November 2023 were included. Recurrence of AF, major adverse cardiovascular events (MACE), redo catheter ablation findings, and echocardiographic outcomes were compared between groups.

Among 127 patients, 13 (10.2%) did not receive LAAO according to their physicians' discretion. The atrial tachyarrhythmia recurrence tended to be higher in the non-LAAO group (hazard ratio [HR] 1.38, 95% confidence interval [CI] 0.68-2.78, p = 0.375). Of the 34 patients who underwent electrophysiology studies, the left pulmonary vein (PV) reconnection rate was significantly higher in the non-LAAO group (odds ratio 19.5, 95% CI 1.61-236.61, p = 0.020). MACE was observed more frequently in the non-LAAO group compared to the LAAO group (23.1% vs. 8.8%, HR 2.83, 95% CI 0.77-10.41, p = 0.117). Adjusted analyses showed lower postoperative E/e' in the LAAO group than in the non-LAAO group (p = 0.014).

Surgical LAAO during thoracoscopic epicardial AF ablation was effective for maintaining durable PV isolation in patients with HF. Thoracoscopic epicardial AF ablation improves LV systolic function regardless of LAAO status, and LAAO was not associated with worsening postoperative diastolic function.