Safety and feasibility of atrial fibrillation ablation after left atrial appendage closure: A single-center experience of the left atrial appendage closure first strategy

Abstract

Background: Patients with atrial fibrillation (AF) who are not suitable for long-term anticoagulant therapy undergo percutaneous left atrial appendage closure (LAAC). The safety and feasibility of left atrial catheter ablation (CA) procedures after LAAC remain unclear. This study aimed to clarify the feasibility and safety of CA after LAAC, including in the early phase within 180 days.

Methods: Characteristics and clinical outcomes of 46 patients with AF who had undergone both CA and LAAC within 2 years (mean age, 72 years; 29 men) were compared between those who had undergone CA-first (31 patients) and LAAC-first (15 patients).

Results: The mean CHA₂DS₂-VASc and HAS-BLED scores were 4.8 and 3.3 points, respectively. The LAAC-first strategy was often used in patients with prior major bleeding and LAA thrombosis or sludge. In the LAAC-first group, the mean duration between both procedures was 212 days, and all LAAC-first patients, including seven patients in the early phase, could undergo CA without LAAC device-related complications; moreover, no cardiovascular adverse events were reported after both procedures (mean periods: 420 days). After CA post-LAAC, no device-related adverse events (device-related thrombosis, new peri-device leak appearance, peri-device leak increase, or device dislodgement) were observed, whereas, after LAAC post-CA, 3 new peri-device leak appearance events and 1 peri-device leak increase event were observed, especially patients who underwent LAAC in the early phase post-CA.

Conclusion: Based on single-center experience, left atrial CA in the presence of an LAAC device implanted including the early phase was safe and feasible.

Keywords: antithrombotic regimen; atrial fibrillation; catheter ablation; left atrial appendage closure; peri‐device leak.

FIGURE 1

Study flow chart. The mean duration between the CA and LAAC procedures in the CA first group was 277 ± 197 days. The mean duration between the LAAC and CA procedures in the LAAC group was 212 ± 172 days. The mean observation periods for both procedures were 464 ± 277 days in the CA first group and 420 ± 260 days in the LAAC first group. CA, catheter ablation; LAAC, percutaneous left atrial appendage closure.

FIGURE 2

Bleeding events between the catheter ablation and percutaneous left atrial appendage closure procedures in the left atrial catheter ablation first group. (Left) Pie chart for the detailed types of bleeding events between the CA and LAAC procedures. (Right) Drugs being used at the time of the bleeding events. CA, catheter ablation; DOAC, direct oral anticoagulant; GI, gastrointestinal; LAAC, percutaneous left atrial appendage closure; SAPT, single antiplatelet therapy; VKA, vitamin K antagonist.

FIGURE 3

Oral antithrombotic drug regimen. (A) Oral antithrombotic drug regimen after left atrial appendage closure in the catheter ablation first group. *Excluding 1 left atrial appendage closure failure patient. (B) Oral antithrombotic drug regimen after ablation in the left atrial appendage closure first group. DAPT, dual antiplatelet therapy; LAAC, percutaneous left atrial appendage closure; NAPT, no antiplatelet therapy; OAC, oral anticoagulant; SAPT, single antiplatelet therapy.