Concomitant vs sequential atrial fibrillation ablation and left atrial appendage occlusion

Increasingly, patients with atrial fibrillation meet the 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 the in-hospital safety of concomitant catheter ablation plus LAAO with the 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 the cumulative patient-level procedural risk. Inverse probability weighted logistic regression was used to compare stroke, major bleeding, and complications between groups.

Among 182,582 LAAO recipients, 20.9% underwent ablation during the study period; 7.7% within ± 6 months, including 1.5% concomitantly. Concomitant and sequential patients were clinically similar; LAAO-only patients were older and had more comorbidities. After adjustment, in-hospital stroke and pericardial effusion did not differ. Major bleeding was approximately 50% lower with concomitant procedures (adjusted odds ratio [aOR], 0.54; 95% CI, 0.42-0.69; P < .01). Vascular complications were also lower (aOR, 0.67; 95% CI, 0.47-0.94; P = .02).

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