The long‐term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and meta‐analysis. (3rd September 2021)

• Record Type: Journal Article
• Authors: Li, Feng; Sun, Jin‐Yu; Wu, Li‐Da; Hao, Jian‐Feng; Wang, Ru‐Xing
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 32:Number 11(2021)
• Page Start: 3068
• Page End: 3081
• Publication Date: 2021-09-03
• Subjects: atrial ablation -- atrial fibrillation -- clinical outcomes -- left atrial appendage closure -- meta‐analysis; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.15230
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Background: Combined ablation and left atrial appendage closure (LAAC) is an alternative for atrial fibrillation patients with a high risk of stroke. However, the long‐term outcomes of this combined procedure remain elusive. Methods: PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long‐term (defined as a mean follow‐up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included. Results: A total of 16 studies comprising 1428 patients were enrolled. The pooled long‐term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI]: 0.59–0.71), long‐term successful rate sealing of LAAC was 1.00 (95% CI: 1.00–1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow‐up was 0.01 (95% CI: 0.00–0.02). Meanwhile, of the periprocedural adverse events, phrenic nerve palsy, intracoronary air embolus, device embolization, and periprocedural death had a rate of 0.00 (95% CI: 0.00–0.00), procedure‐related bleeding events of 0.03 (95% CI: 0.02–0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI: 0.00–0.01). Moreover, for the long‐term adverse events, device dislocation, intracranial bleeding, pericardial effusion requiring or not requiring intervention, and all‐cause mortality had a rate of 0.00 (95% CI: 0.00–0.00), device embolization of 0.01 (95% CI: 0.00–0.01), and other bleeding events of 0.01 (95% CI: 0.00–0.03). Conclusion: This meta‐analysis suggests that the combined atrial ablation and LAAC is an effective and safe strategy with long‐term benefits.