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Updated: Aug 5, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Combined Direct Current Cardioversion and Left Atrial Appendage Occlusion in Patients With Contraindication to
Lawrence Chen1, Tai Pham1, Edris Aman1
1Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
Insights
Direct current cardioversion (DCCV) followed by left atrial appendage occlusion (LAAO) is a feasible strategy for atrial fibrillation patients unable to take oral anticoagulation. This combined approach showed promising safety and efficacy in a pilot study.
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 risks of atrial stunning and thromboembolism.
- Some patients cannot tolerate post-DCCV OAC, necessitating alternative strategies.
- Left atrial appendage occlusion (LAAO) offers an OAC-sparing option, but its use immediately after DCCV is not well-established.
Purpose of the Study:
- To evaluate the feasibility and safety of performing DCCV immediately followed by percutaneous LAAO.
- To assess early and intermediate clinical and imaging outcomes of this combined procedural strategy.
- To determine if this approach is a viable OAC-sparing alternative for select atrial fibrillation patients.
Main Methods:
- Retrospective single-center study of consecutive atrial fibrillation patients with contraindications to post-DCCV OAC.
- Patients underwent planned DCCV immediately followed by percutaneous LAAO using Watchman FLX or FLX Pro devices.
- Outcomes assessed included procedural success, in-hospital events, and follow-up imaging (cardiac CT or TEE) and clinical events at 45 days, 3 months, and 1 year.
Main Results:
- Twelve patients (mean age 75 years) underwent combined DCCV + LAAO; 67% had a history of bleeding.
- Acute DCCV success was 92%, and LAAO technical success was 100%. Mean procedure time was 48 minutes.
- At 1 year, no strokes or systemic embolic events occurred; 1 cardiovascular death was noted. One low-risk device-related thrombus (9%) and 18% peri-device leak >3 mm were observed.
Conclusions:
- A combined DCCV + LAAO strategy is feasible in patients with contraindications to post-cardioversion OAC.
- This approach demonstrated acceptable early and intermediate safety and efficacy, comparable to standalone LAAO.
- Larger prospective studies are warranted to further validate this OAC-sparing treatment strategy.
Background:
Direct current cardioversion (DCCV) for atrial fibrillation is typically followed by 3 to 4 weeks of oral anticoagulation (OAC) because of atrial stunning and thromboembolic risk, which some patients cannot tolerate. Left atrial appendage occlusion (LAAO) provides an OAC-sparing alternative, but the feasibility of performing DCCV immediately before LAAO has not been well defined.
Methods:
We conducted a retrospective single-center study of consecutive patients with atrial fibrillation with relative or absolute contraindications to post-cardioversion OAC who underwent planned DCCV immediately followed by percutaneous LAAO using Watchman FLX or FLX Pro devices. Procedural characteristics, in-hospital outcomes, follow-up imaging findings, and clinical outcomes at 45 days, 3 months, and 1 year were assessed using cardiac computed tomography or transesophageal echocardiography.
Results:
Twelve patients underwent concomitant DCCV + LAAO (mean age 75 ± 9 years; 33% women). Bleeding history was present in 67%, with mean CHA2DS2-VASc and HAS-BLED scores of 3.7 ± 1.1 and 2.1 ± 0.7, respectively. Acute DCCV success was achieved in 11 patients (92%), and LAAO technical success was 100%. Mean procedure time was 48 ± 15 minutes. Follow-up imaging was completed in 12 patients and identified 1 low-risk device-related thrombus (9%), peri-device leak >3 mm in 18%, and no leaks >5 mm. At 45 days and 3 months, there were no deaths, strokes, systemic embolic events, or major bleeding events. At 1 year (n = 7), 1 cardiovascular death occurred without thromboembolic or major bleeding complications.
Conclusions:
In this pilot series, a combined DCCV + LAAO strategy was feasible and not associated with excess thromboembolic or bleeding events. Early and intermediate outcomes were comparable to contemporary standalone LAAO experience. Larger prospective studies are needed to further evaluate this OAC-sparing approach.
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