Left atrial appendage occlusion and concomitant catheter ablation procedures.

BACKGROUND: The safety and effectiveness of concomitant catheter ablation at the time of left atrial appendage (LAA) occlusion (LAAO) are not well characterized. OBJECTIVE: This study aimed to describe the safety and effectiveness of LAAO during concomitant ablation of atrial fibrillation (AF) with LAAO performed as a stand-alone procedure. METHODS: Patients from the Surveillance Postapproval Analysis Plan who underwent concomitant ablation and LAAO were compared with patients who underwent LAAO alone. The primary effectiveness end point was complete seal of the LAA, and the primary safety end point was the occurrence of major adverse events at 45 days. RESULTS: Among 96,968 patients, 1.9% (n = 1844) underwent concomitant ablation; these patients were younger (median 73 [quartile 1, quartile 3 68-78] vs 76 [72-82] years) and had lower CHA2DS2-VASc scores (4 [3-5] vs 5 [4-6]), previous clinically relevant bleeding (32.4% vs 56.6%), or fall risk (30.2% vs 42.2%). The most common discharge drug therapy in the concomitant AF ablation group was direct-acting oral anticoagulant plus aspirin (56.2%), followed by direct-acting oral anticoagulant alone (30.0%). Immediately after implant, patients undergoing concomitant ablation had lower rates of any residual leak (1.6% vs 3.7%; P < .001); no difference was seen at 45 days (15.7% vs 16.9%; P = .29). In-hospital major adverse events were more frequent in those undergoing LAAO with concomitant ablation than LAAO without ablation (1.9% vs 1.2%; P = .0111). In-hospital major bleeding (1.6% vs 1.0%; P = .0073) and pericardial effusion requiring intervention (0.8% vs 0.4%; P = .0108) were more frequent with combined LAAO and AF ablation. At 1 year after the procedure, the composite of all-cause mortality, stroke, or systemic embolism was less frequent in those undergoing LAAO with concomitant ablation (5.2% vs 9.3%; P < .0001). CONCLUSION: Patients undergoing concomitant AF ablation at the time of LAAO are younger and have fewer comorbidities. There was no clinically important difference in LAA seal peridevice leaks with concomitant LAAO; however, there was a higher rate of major bleeding and pericardial effusion requiring intervention.

Duke Scholars

Author Jonathan Paul Piccini Sr. Medicine, Cardiology