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Updated: Aug 6, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Clinical Outcomes of Different Stroke Prevention Strategies in Patients With Inadvertent Left Atrial Appendage
Shaohui Wu1, Jiongchao Guo1, Juan Du1
1Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Left atrial appendage closure (LAAC) after ablation for persistent atrial fibrillation (AF) with inadvertent electrical isolation may reduce bleeding risk. This strategy showed comparable efficacy to long-term direct oral anticoagulants (DOACs).
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Inadvertent left atrial appendage electrical isolation (LAAEI) during persistent atrial fibrillation (AF) ablation is linked to increased thromboembolic risk.
- Optimal antithrombotic management following LAAEI remains undetermined.
Purpose of the Study:
- To compare the safety and efficacy of left atrial appendage closure (LAAC) within 3 months post-ablation versus long-term direct oral anticoagulants (DOACs).
- To evaluate outcomes in persistent AF patients experiencing inadvertent LAAEI during catheter ablation.
Main Methods:
- Retrospective analysis of 225 patients with inadvertent LAAEI during persistent AF ablation (Jan 2019-Mar 2024).
- Propensity score matching (PSM) created two groups (n=72 each): LAAC within 3 months and long-term DOACs.
- Outcomes assessed included bleeding events, thromboembolic events, and atrial arrhythmia recurrence over a mean 827-day follow-up.
Main Results:
- The LAAC group exhibited significantly lower rates of non-procedure-related major and clinically relevant nonmajor bleeding compared to the DOAC group (HR=0.417, p=0.034).
- Thromboembolic event rates were comparable between the groups (HR=0.246, p=0.205).
- Atrial arrhythmia recurrence rates were also similar (HR=0.939, p=0.054).
Conclusions:
- Left atrial appendage closure (LAAC) performed within 3 months post-ablation may offer a reduced bleeding risk for patients with inadvertent LAAEI.
- LAAC demonstrates comparable efficacy to long-term DOACs in this specific patient population.
- LAAC is a safe and effective therapeutic strategy for managing inadvertent LAAEI during persistent AF ablation.
Background:
Inadvertent left atrial appendage electrical isolation (LAAEI) during persistent atrial fibrillation (AF) ablation increases thromboembolic risk. The optimal antithrombotic strategy for these patients remains unclear.
Objectives:
This study aimed to compare the safety and efficacy of left atrial appendage closure (LAAC) performed within 3 months after catheter ablation versus long-term postoperative received direct oral anticoagulants (DOACs) in patients with persistent AF who experienced inadvertent LAAEI during catheter ablation.
Methods:
The single-center retrospective analysis included 225 patients with inadvertent LAAEI during persistent AF ablation between January 2019 and March 2024. After propensity score matching (PSM), 144 patients were analyzed: 72 received LAAC (LAAC group), and 72 received DOACs (DOAC group). Outcomes, including bleeding and thromboembolic events, were assessed over a mean follow-up of 827 days.
Results:
The LAAC group had significantly fewer non-procedure-related major and clinically relevant nonmajor bleeding events compared to the DOAC group (HR = 0.417, 95% CI: 0.181-0.960, p = 0.034). Thromboembolic events were similar (HR = 0.246, 95% CI: 0.071-0.851, p = 0.205). Atrial arrhythmia recurrence rates were comparable (HR = 0.939, 95% CI: 0.587-1.502, p = 0.054). Normal LAA function was observed in 41.67% of the DOAC group, while the LAAC group had two cases of device-related thrombus resolved with anticoagulation.
Conclusions:
LAAC within 3 months after catheter ablation may reduce bleeding risk while maintaining efficacy comparable to long-term DOACs in patients with inadvertent LAAEI. LAAC represents a safe and effective strategy for this population.
