22-05: Combining LAA closure and catheter ablation for long-term stroke prevention: multicenter registry results of feasibility, efficacy, and safety during implant and 30 days follow-up. (10th June 2016)

• Record Type: Journal Article
• Authors: Boersma, Lucas V; Pokushalov, Evgeny; Romanov, Alexander; Artemenko, Sergey; Folkeringa, Richard; Szili-Torok, Tamas; Senatore, Gaetano; Stein, Kenneth M; Omar, Razali; Phillips, Karen
• Is Part Of: Europace. Volume 18(2016)Supplement 1
• Page Start: i26
• Page End: i26
• Publication Date: 2016-06-10
• Subjects: Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/18.suppl_1.i26b
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Introduction: Long-term outcomes of catheter ablation (CA) to treat drug-refractory AF remain disappointing. Clinical guidelines therefore recommend continuation of oral anticoagulation therapy (OAT) in patients at high risk of stroke. Left atrial appendage closure with Watchman (LAAC) has emerged as a good alternative, offering long-term stroke prevention regardless of CA outcome. We describe the initial results of combining both techniques in a single procedure. Methods: Data were pooled from 2 large prospective, real-world, multicenter Watchman LAAC registries running in parallel in Europe/Middle-East/Russia (EWOLUTION) and Asia/Australia (WASP) between 2013 and 2015. All patients undergoing CA and LAAC were compared to stand-alone LAAC. CA included pulmonary vein isolation by any technique with additional substrate modification at the discretion of individual centers. Data were analyzed to determine feasibility and success, as well as safety of the procedure throughout 30 days of follow-up. Results: Of the 1143 patients with Watchman LAAC, 145 also underwent CA for AF at 12 centers. There was no significant difference in gender distribution (45% vs 37% female in the CA vs LAAC-only group, p = 0.1), but patients selected for CA were younger (64 ± 7 vs 74 ± 8 yrs, p < 0.0001), with lower CHA2DS2-VASc (3.4 ± 1.4 vs 4.5 ± 1.6), CHADS2 (2.2 ± 1.2 vs 2.8 ± 1.3) and HAS-BLED score (1.5 ± 0.9 vs 2.4 ± 1.2) (all 3 scores: p < 0.0001); 66% had paroxysmal AF, compared to 41% in the LAAC-only group (p < 0.0001). In the CA group, ablation was followed by a successful Watchman implant in all 145 patients, compared to 98.4% of 998 patients in the LAAC-only group. In the CA group more patients had complete closure at implant (97% vs 91%, p = 0.03). The serious adverse (7.6% in both groups) and device/procedure related (1.4% CA vs 3.3% LAAC group) event rates did not differ between the groups. In the CA group there were 2 pericardial effusions (only 1 requiring percutaneous intervention), but no strokes, device embolization or deaths at 30 days. 90% of CA patients were discharged on OAT, compared to 23% in the LAAC-only group. Post-implant OAT in the CA group was warfarin in 37%, NOAC in 52% and antiplatelet therapy or none in 10%. Nevertheless, serious bleeding rates were equally low in both groups (2.1% CA vs 2.5% LAAC group). According to TEE follow-up available in 889 patients, successful sealing (none or ≤5 mm jet) was achieved in 99.1% of patients. Conclusion: This pooled analysis of combined CA and LAAC shows that the procedure is equally feasible, successful and safe compared to stand-alone LAAC. Long-term follow-up is needed to determine the relation between freedom of AF, outcomes of repeated CA, and stroke, embolism and death rates.