Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 14;3(12):101377.
doi: 10.1016/j.jacadv.2024.101377. eCollection 2024 Dec.

Outcomes of Concomitant Atrial Fibrillation Ablation and Left Atrial Appendage Closure: A Retrospective Single-Center Experience

Ashraf Alzahrani  1 , Oussama M Wazni  2 , Ayman Hussein  2 , Chadi Tabaja  2 , Rehan Karmali  2 , Himanshu Sajja  2 , Benjamin Klein  2 , Saqer Alkharabsheh  2 , Arwa Younis  2 , Joseph Sipko  2 , Astefanos Al Dalakta  2 , Alveena Syed Batool  2 , Eoin Donnelan  3   2 , Shady Nakhla  2 , Bryan Baranowski  2 , Mandeep Bhargava  2 , Thomas Callahan  2 , Thomas Dresing  2 , Pasquale Santangeli  2 , David Martin  2 , John Rickard  2 , Koji Higuchi  2 , Jakub Sroubek  2 , Wael A Jaber  2 , Samir R Kapadia  2 , Tyler Taigen  2 , Walid Saliba  2 , Mohamed Kanj  2
Affiliations

Outcomes of Concomitant Atrial Fibrillation Ablation and Left Atrial Appendage Closure: A Retrospective Single-Center Experience

Ashraf Alzahrani et al. JACC Adv. .

Abstract

Background: Catheter ablation is an effective therapy in the management of atrial fibrillation (AF). Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention in patients with bleeding risks.

Objectives: The purpose of this study was to assess the safety and efficacy of combining AF ablation and LAAC in a single procedure.

Methods: This retrospective observational study included consecutive patients who underwent concomitant AF ablation and LAAC between June 2015 and August 2021. We assessed the safety and efficacy of the combined procedure with respect to procedural success, periprocedural complications, thromboembolism, bleeding, and arrhythmia recurrence.

Results: A total of 178 patients (mean age 72.1 ± 8.7 years, 60.7% male) were identified. The mean CHA2DS2VASc and HAS-BLED scores were 4.0 ± 1.4 and 2.8 ± 1.1, respectively. Pulmonary vein isolation was achieved in all patients. LAAC was aborted in 15 cases (success rate of 91.6%). The periprocedural complications rate was 6.2%. The median follow-up duration was 412 days IQR: 213 to 781 days. There were 2 strokes and 3 transient ischemic attacks, equating to an annual risk of 1.7% at 1 year and 4.6% at 2 years. Complete seal was achieved in 97.5% intraprocedurally and in 73.7% on initial follow-up, with no major leaks identified. There were 2 cases (1.3%) of device-related thrombus that resolved with anticoagulation. Thirty-four bleeding events occurred in 28 patients (17.4%). Anticoagulation was discontinued in 93.8% of patients.

Conclusions: Concomitant AF ablation and LAAC could be considered in appropriate patients in centers of clinical expertise.

Keywords: WATCHMAN; atrial fibrillation; catheter ablation; device occlusion; left atrial appendage closure.

PubMed Disclaimer

Conflict of interest statement

Dr Wazni has served as a consultant for Biosense Webster and Boston Scientific. Dr Callahan has served as a consultant for Biotronics and Philips. Dr Santangeli has received speaking honorarium from Boston Scientific. Dr Rickard has received research grant from 10.13039/100008497Boston Scientific, 10.13039/100004374Medtronic, Ireland, and 10.13039/100000046Abbott. Dr Taigen has served as a consultant for Medtronic and Biosense Webster. Dr Jaber has served as a consultant for Boston Scientific and Pfizer. Dr Saliba has served as an advisory board member for Boston Scientific. Dr Kanj has received speaking honorarium from Boston Scientific; and has served as a consultant for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Procedural Success (A) Overall procedural success rate. (B) Reasons for aborting the LAAC portion. (C) Procedural success rate stratified by device type. LAA = left atrial appendage.
Central Illustration
Central Illustration
Outcomes of Concomitant Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion DRT = device-related thrombus; TIA = transient ischemic attack.
Figure 2
Figure 2
Device Tilting Seen With Significant Coumadin Ridge Edema at the Landing Zone (A) TEE at the time of device implant. (B) TEE at 95 days post-implant. TEE = transesophageal echocardiogram.
See this image and copyright information in PMC

References

    1. Packer D.L., Mark D.B., Robb R.A., et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321(13):1261. doi: 10.1001/jama.2019.0693. - DOI - PMC - PubMed
    1. Mark D.B., Anstrom K.J., Sheng S., et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321(13):1275. doi: 10.1001/jama.2019.0692. - DOI - PMC - PubMed
    1. Blomström-Lundqvist C., Gizurarson S., Schwieler J., et al. Effect of catheter ablation vs antiarrhythmic medication on quality of life in patients with atrial fibrillation: the CAPTAF randomized clinical trial. JAMA. 2019;321(11):1059. doi: 10.1001/jama.2019.0335. - DOI - PMC - PubMed
    1. Barra S., Baran J., Narayanan K., et al. Association of catheter ablation for atrial fibrillation with mortality and stroke: a systematic review and meta-analysis. Int J Cardiol. 2018;266:136–142. doi: 10.1016/j.ijcard.2018.03.068. - DOI - PubMed
    1. Joza J., Samuel M., Jackevicius C.A., et al. Long-term risk of stroke and bleeding post-atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2018;29:1355–1362. - PubMed

LinkOut - more resources