The long-term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and meta-analysis

J Cardiovasc Electrophysiol. 2021 Nov;32(11):3068-3081. doi: 10.1111/jce.15230. Epub 2021 Sep 3.


Background: Combined ablation and left atrial appendage closure (LAAC) is an alternative for atrial fibrillation patients with a high risk of stroke. However, the long-term outcomes of this combined procedure remain elusive.

Methods: PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included.

Results: A total of 16 studies comprising 1428 patients were enrolled. The pooled long-term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI]: 0.59-0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI: 1.00-1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow-up was 0.01 (95% CI: 0.00-0.02). Meanwhile, of the periprocedural adverse events, phrenic nerve palsy, intracoronary air embolus, device embolization, and periprocedural death had a rate of 0.00 (95% CI: 0.00-0.00), procedure-related bleeding events of 0.03 (95% CI: 0.02-0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI: 0.00-0.01). Moreover, for the long-term adverse events, device dislocation, intracranial bleeding, pericardial effusion requiring or not requiring intervention, and all-cause mortality had a rate of 0.00 (95% CI: 0.00-0.00), device embolization of 0.01 (95% CI: 0.00-0.01), and other bleeding events of 0.01 (95% CI: 0.00-0.03).

Conclusion: This meta-analysis suggests that the combined atrial ablation and LAAC is an effective and safe strategy with long-term benefits.

Keywords: atrial ablation; atrial fibrillation; clinical outcomes; left atrial appendage closure; meta-analysis.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Atrial Appendage* / diagnostic imaging
  • Atrial Appendage* / surgery
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / surgery
  • Cardiac Surgical Procedures*
  • Catheter Ablation* / adverse effects
  • Humans
  • Stroke* / etiology
  • Stroke* / prevention & control
  • Treatment Outcome