Combining catheter ablation and left atrial appendage occlusion in high-risk patients with atrial fibrillation: A propensity score-matched analysis

Ziyong Hao; Bin Liu; Xiaoyi Xie; Yiting Fan; Jian Wang; Qin Shao; Lisheng Jiang; Ben He

doi:10.1016/j.hjc.2024.03.002

Combining catheter ablation and left atrial appendage occlusion in high-risk patients with atrial fibrillation: A propensity score-matched analysis

Hellenic J Cardiol. 2024 Mar 7:S1109-9666(24)00057-5. doi: 10.1016/j.hjc.2024.03.002. Online ahead of print.

Authors

Ziyong Hao¹, Bin Liu¹, Xiaoyi Xie², Yiting Fan¹, Jian Wang¹, Qin Shao¹, Lisheng Jiang³, Ben He⁴

Affiliations

¹ Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Ultrasonography, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: jls1025@aliyun.com.
⁴ Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: heben241@126.com.

PMID: 38460616
DOI: 10.1016/j.hjc.2024.03.002

Abstract

Background: The safety and efficacy of a combined approach of catheter ablation (CA) and left atrial appendage occlusion (LAAO) compared to LAAO alone remain unknown.

Methods: Patients with atrial fibrillation (AF) at increased stroke risk who underwent LAAO were divided into either combined (CA and LAAO) procedure or LAAO alone group. Propensity score matching was utilized to balance baseline characteristics. The primary endpoint of the study was a composite of death, thromboembolic events, major bleeding, heart failure (HF) rehospitalization and major periprocedural complications.

Results: A total of 707 AF patients who underwent LAAO were included. After 1:1 propensity score matching, 166 patients who underwent LAAO alone (n=83) or the combined procedure (n=83) were analyzed. Successful LAAO was achieved in all (100%) patients, with a low incidence of periprocedural complications in both groups (2.4% vs. 4.8%, LAAO vs. combined, p=0.68). The incidence of peri-device leak post-LAAO was significantly higher in the combined group (25.3% vs. 43.4%, p=0.01). After a median follow-up of 2 years, there were no significant differences in the rates of the primary composite endpoint between the two strategies (22.2% vs. 14.3%, HR: 1.24 [95% CI: 0.51-2.97], p=0.63). However, the rate of HF rehospitalization was significantly lower in the combined group (19.6% vs. 3.6%, HR: 4.89 [95% CI: 1.50-15.97], p=0.024).

Conclusions: Combining CA and LAAO in a "one-stop" approach is safe and brings additional benefit in relieving symptoms of heart failure, although peri-device leak was more common compared to LAAO alone.

Keywords: atrial fibrillation; catheter ablation; heart failure; left atrial appendage occlusion; peri-device leak.