Concomitant Versus Sequential Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion

Increasingly, atrial fibrillation patients meet indications for rhythm control with catheter ablation and stroke prevention with left atrial appendage occlusion (LAAO).

To assess the frequency of both procedures and compare in-hospital safety of concomitant catheter ablation plus LAAO with cumulative patient-level risk across sequential procedures.

A retrospective analysis of Medicare fee-for-service beneficiaries with index LAAO (January 1, 2017-June 30, 2024) was conducted. Beneficiaries were classified as LAAO only, sequential ablation and LAAO (±6 months), or concomitant. Procedure utilization and in-hospital outcomes were evaluated. For the sequential cohort, events from both encounters were combined to reflect cumulative patient-level procedural risk. Inverse probability weighted logistic regression compared stroke, major bleeding, and complications between groups.

Among 182,582 LAAO recipients, 20.9% underwent ablation during the study period; 7.7% ±6 months, including 1.5% concomitantly. Concomitant and sequential patients were clinically similar; LAAO-only patients were older with more comorbidities. After adjustment, in-hospital stroke and pericardial effusion did not differ. Major bleeding was approximately 50% lower with concomitant procedures (aOR 0.54, 95% CI, 0.42-0.69; p<0.01). Vascular complications were also lower (aOR 0.67, 95% CI, 0.47-0.94, p=0.02).

Concomitant ablation and LAAO demonstrated comparable in-hospital stroke and pericardial effusion risk, but lower observed risks of bleeding and vascular complications compared with cumulative risk across sequential procedures, supporting single-session approach when clinically appropriate.