Combined Direct Current Cardioversion and Left Atrial Appendage Occlusion in Patients With Contraindication to...

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Direct current cardioversion (DCCV) for atrial fibrillation typically requires 3-4 weeks of oral anticoagulation (OAC) due to thromboembolic risk.
• Some patients cannot tolerate post-DCCV OAC, necessitating alternative strategies.
• Left atrial appendage occlusion (LAAO) offers an OAC-sparing option, but its combination with immediate DCCV is not well-defined.

Purpose of the Study:

• To evaluate the feasibility and safety of performing DCCV immediately followed by percutaneous LAAO.
• To assess procedural outcomes and clinical events in patients with contraindications to post-cardioversion OAC.

Main Methods:

• Retrospective single-center study of 12 patients with atrial fibrillation undergoing planned DCCV followed by LAAO (Watchman FLX/FLX Pro).
• Patients had contraindications to post-DCCV OAC.
• Outcomes assessed included procedural success, in-hospital events, and clinical follow-up at 45 days, 3 months, and 1 year via imaging and clinical data.

Main Results:

• Concomitant DCCV + LAAO was performed in 12 patients (mean age 75 years; 67% with bleeding history).
• Acute DCCV success was 92%, and LAAO technical success was 100%.
• At 1 year, no strokes or systemic embolic events occurred; one cardiovascular death was noted without thromboembolic or major bleeding complications.

Conclusions:

• A combined DCCV + LAAO strategy is feasible and safe for selected atrial fibrillation patients.
• This approach appears to be an effective OAC-sparing alternative.
• Further prospective studies are warranted to validate these findings.