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Updated: Aug 19, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Efficacy and safety of concomitant catheter ablation and left atrial appendage closure compared to catheter ablation
Isabel Rattka1, Christine Poch1, Tabea Deichsel1
1School of Medicine and Health, Department of Clinical Medicine-Clinical Department of Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany.
Insights
Combined catheter ablation (CA) and left atrial appendage closure (LAAC) increases arrhythmia recurrence compared to CA alone. Safety outcomes like pericardial effusion did not differ significantly between the two procedures.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Atrial fibrillation (AF) poses a significant stroke risk, primarily from the left atrial appendage (LAA).
- Catheter ablation (CA) and percutaneous left atrial appendage closure (LAAC) are key strategies for stroke prevention and rhythm control in AF.
- Combining CA and LAAC in a single procedure is emerging, but its effects on rhythm and safety are not well-established.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of combined CA + LAAC versus CA-only in AF patients.
- To compare arrhythmia recurrence and periprocedural complications between the two treatment strategies.
Main Methods:
- A systematic review and meta-analysis of studies comparing combined CA + LAAC with CA-only.
- Searches conducted in PubMed, Scopus, and Web of Science up to June 12th, 2026.
- Primary outcomes: arrhythmia recurrence and pericardial effusion requiring drainage. Pooled data using random-effects models.
Main Results:
- Fourteen studies with 3,274 patients were analyzed (1,505 CA+LAAC, 1,769 CA-only).
- Combined CA+LAAC showed significantly higher arrhythmia recurrence (OR=1.56, 95% CI=1.11-2.19).
- No significant difference in systemic thromboembolism or pericardial effusion requiring drainage was observed. Procedure time was longer for combined therapy.
Conclusions:
- Combined CA+LAAC is associated with increased arrhythmia recurrence compared to CA-only.
- The primary safety outcome, pericardial effusion, did not differ significantly.
- Further randomized controlled trials are needed to validate these findings and explore substrate modification limitations.
Background:
Atrial fibrillation (AF) carries a substantial ischemic stroke risk originating predominantly from the left atrial appendage (LAA). Catheter ablation (CA) is the most effective rhythm-control strategy, while percutaneous LAA closure (LAAC) provides mechanical stroke prophylaxis. Combining both in a single one-stop procedure is increasingly performed, yet data on its rhythmic and periprocedural consequences remain scarce.
Methods:
We performed a systematic review and meta-analysis to compare the efficacy and safety of combined CA + LAAC versus CA-only in patients with AF. PubMed, Scopus and Web of Science were searched through June 12th 2026. The primary efficacy and safety outcomes were arrhythmia recurrence and periprocedural pericardial effusion requiring drainage, respectively. Binary endpoints were pooled as odds ratios (OR), continuous endpoints as mean differences (MD), using a random-effects model with heterogeneity reported as I2.
Results:
Fourteen studies comprising 3,274 patients (1,505 CA + LAAC; 1,769 CA-only) were included. Arrhythmia recurrence was significantly more frequent after combined CA + LAAC (OR = 1.56, 95% CI = 1.11-2.19, I2 = 47%). Systemic thromboembolism was numerically lower but did not differ significantly (OR = 0.66, 95% CI = 0.37-1.21, I2 = 0%). Total procedure time was significantly longer for the combined procedure (MD = + 9.34 min, 95% CI = 0.63-18.05, I2 = 90%). Periprocedural pericardial effusion requiring drainage did not differ between groups (OR = 1.19, 95% CI = 0.59-2.44, I2 = 0%).
Conclusion:
Combined CA + LAAC was associated with significantly higher arrhythmia recurrence than CA-only, potentially attributable to limited substrate modification in the one-stop setting. The primary safety outcome, pericardial effusion requiring drainage, did not differ between groups. Randomised controlled trials are warranted to confirm these findings.
