Long-term outcome of combined catheter ablation and left atrial appendage closure in atrial fibrillation patients. (1st December 2022)

• Record Type: Journal Article
• Authors: Chen, Mu; Sun, Jian; Wang, Qun-Shan; Zhang, Peng-Pai; Li, Wei; Zhang, Rui; Mo, Bin-Feng; Yu, Yi-Chi; Cai, Xingxing; Yang, Mei; Lian, Xiao-Ming; Zhao, Yan; Gong, Changqi; Yu, Yi; Liu, Bo; Feng, Xiangfei; Lu, Qiufen; Li, Yi-Gang
• Is Part Of: International journal of cardiology. Volume 368(2022)
• Page Start: 41
• Page End: 48
• Publication Date: 2022-12-01
• Subjects: Arrhythmia -- Anticoagulation -- Thromboembolism -- Stroke -- Bleeding; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.08.007
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The combined procedure of catheter ablation and left atrial appendage closure (LAAC) aims to simultaneously control the heart rhythm and reduce the risk of strokes in patients with atrial fibrillation (AF). The study aims to evaluate the procedural safety and long-term outcome of the combined procedure in a large patient cohort. Methods: Clinical data of AF patients who underwent the combined procedure was retrospectively analyzed. Procedural and imaging follow-up parameters were compared between the transesophageal echocardiography-guided standard process and fluoroscopy-guided modified process, and between the single-seal WATCHMAN and dual-seal LACBES devices. Long-term outcomes included all-cause mortality, thromboembolic events, major bleeding, and recurrence of atrial tachyarrhythmias. Results: A total of 1114 patients were included. The rates of procedure-related major complications were comparable between the standard and modified processes (3.7% vs. 2.2%, p = 0.219), except for a higher incidence of respiratory depression in standard process group (0.9% vs 0%, p = 0.037), and between WATCHMAN and LACBES devices (2.4% vs. 3.3%, p = 0.535). The follow-up imaging evaluation revealed a high rate of satisfactory seals (99.7%) and a low rate of device related thrombus (1.9%), which were similar between two process groups and devices. The follow-up of over 1960 patient-years revealed low rates of mortality, thromboembolism, and nonprocedural major bleeding (1.8, 3.2, and 0.9 per 100 patient-years, respectively). Recurrent atrial tachyarrhythmias was observed in 23.9% patients. Conclusions: The results supported the safety and long-term efficacy of the combined procedure of catheter ablation and LAAC. Fluoroscopy-guided LAAC device implantation may be considered in experienced centers. Highlights: The safety of the combined procedure of catheter ablation and left atrial appendage closure was acceptable. Despite a longer fluoroscopy time, the fluoroscopy-guided process had lower risks of respiratory depression and a shorter procedure time and required less workers than the transesophageal echocardiography-guided process. Long-term event rates of the combined procedure were low, including mortality, thromboembolic events, and major bleeding events.