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. 2025 Jun;68(4):767-775.
doi: 10.1007/s10840-024-01914-8. Epub 2024 Sep 11.

Catheter ablation for atrial fibrillation in patients with prior left atrial appendage occlusion device

Jakrin Kewcharoen  1 , Kuldeep Shah  2 , Rahul Bhardwaj  1 , Tahmeed Contractor  1 , Davendra Ramsingh  3 , Mohit K Turagam  4 , Ravi Mandapati  1 , Dhanunjaya Lakkireddy  5 , Jalaj Garg  6
Affiliations

Catheter ablation for atrial fibrillation in patients with prior left atrial appendage occlusion device

Jakrin Kewcharoen et al. J Interv Card Electrophysiol. 2025 Jun.

Abstract

Background: The safety and efficacy of CA for AF and left-sided atrial arrhythmias (AA) in patients with left atrial appendage occlusion (LAAO) devices are lacking.

Methods: This is a single-center retrospective registry that included all patients with prior LAAO who underwent catheter ablation for AF or left-sided atrial arrhythmia from January 2020-January 2023. The primary outcomes were procedure-related complications, device-related complications, AA recurrence, and stroke.

Results: A total of 30 patients with prior LAAO were included in the analysis (mean age 75.1 ± 7.1 years old, 50% male, mean CHA2DS2-VASc score 4 ± 1.6, 46.7% paroxysmal AF, 73.3% had prior AF ablation, mean time to ablation 475 ± 365 days). 93.3% (n = 28) and 6.6% (n = 2) patients had ablation for AF (46.7% paroxysmal, 36.7% persistent, 10% long-standing persistent) and left-sided atrial tachycardia, respectively. 16.7% (n = 5) patients underwent ablation along the left atrial appendage ostium, and 3.3% (n = 1) underwent Vein of Marshall alcohol ablation. There were 3 (10%) peri-procedural complications (1 access hematoma and two pericardial effusions requiring intervention-none related to left atrial appendage ostium or alcohol ablation). During the mean follow-up of 440 ± 379 days, 40% (n = 12) patients had AA recurrence (91.6% AF, 8.3% atrial tachycardia), of which five patients needed repeat ablation, and two patients were readmitted for heart failure. There was no stroke or any device-related complications, including new peri-device leaks or device-related thrombosis in patients who had follow-up imaging studies (n = 11, 36.7%).

Conclusion: Catheter ablation for AF (including VoM alcohol ablation) in patients with prior LAAO devices is feasible and safe with favorable outcomes.

Keywords: Ablation; Atrial fibrillation; Left atrial appendage occlusion.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

References

    1. Wilber DJ, Pappone C, Neuzil P, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010;303:333–40. - PubMed
    1. Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149:e1–156. - PubMed
    1. Investigators AWGotA, Connolly S, Pogue J et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events (ACTIVE W): a randomised controlled trial. Lancet (London, England) 2006;367:1903–12.
    1. Grimaldi-Bensouda L, Le Heuzey JY, Ferrieres J, et al. Stroke prevention by anticoagulants in daily practice depending on atrial fibrillation pattern and clinical risk factors. Stroke. 2021;52:3121–31. - PubMed
    1. Holmes DR, Reddy VY, Turi ZG, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. 2009;374:534–42. - PubMed

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