Combined left atrial appendage occlusion and catheter ablation procedure for left atrial arrhythmias: A real-world, propensity-matched analysis

Stefan Preisendörfer; Muhammad T Ayub; Aakash Sheth; George Y Jabbour; Madhurmeet Singh; Chinmay P Patel; Hemal Gada; Aditya Bhonsale; Mehak Dhande; Nathan A Estes; Krishna Kancharla; Dustin E Kliner; Amber Makani; Aditi Naniwadekar; Alaa Shalaby; Virginia Singla; Andrew Voigt; Samir F Saba; Sandeep K Jain

doi:10.1111/jce.16466

Combined left atrial appendage occlusion and catheter ablation procedure for left atrial arrhythmias: A real-world, propensity-matched analysis

J Cardiovasc Electrophysiol. 2024 Dec;35(12):2423-2431. doi: 10.1111/jce.16466. Epub 2024 Oct 15.

Authors

Stefan Preisendörfer¹, Muhammad T Ayub¹, Aakash Sheth¹, George Y Jabbour¹, Madhurmeet Singh¹, Chinmay P Patel¹, Hemal Gada¹, Aditya Bhonsale¹, Mehak Dhande¹, Nathan A Estes¹, Krishna Kancharla¹, Dustin E Kliner¹, Amber Makani¹, Aditi Naniwadekar¹, Alaa Shalaby¹, Virginia Singla¹, Andrew Voigt¹, Samir F Saba¹, Sandeep K Jain¹

Affiliation

¹ Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Abstract

Introduction: Real-world studies comparing safety and efficacy of combined percutaneous left atrial appendage occlusion (LAAO) and catheter ablation (CA) to LAAO alone are limited.

Methods: Patients from a large US hospital system undergoing combined LAAO and left-atrial CA from 8/2020 to 2/2024 were retrospectively analyzed and compared to a control group undergoing LAAO alone. Controls were identified using a 1:2 propensity score match based on LAAO device type (Watchman FLX vs. Amulet), CHA₂D₂-VASc and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio [INR], Elderly, Drugs/alcohol (HAS-BLED) scores and compared for safety, sealing performance and clinical outcomes at 6 months.

Results: Patients were younger in the combined (n = 72) than in the control group (n = 144, 70.2 ± 7.3 vs. 76.7 ± 6.9 years, p < 0.001) but otherwise comparable with a mean CHA₂D₂-VASc score of 4.2 ± 1.1 and 4.4 ± 1.2 (p = 0.26) and HAS-BLED score of 2.2 ± 0.8 and 2.3 ± 0.7 (p = 0.34). Successful LAAO implantation rates were the same (95.8% vs. 95.8%, p = 0.99) with longer procedure times seen in the combined group (156.5 ± 53 vs. 56 ± 26 min, p < 0.001). Both major (1.4% vs. 2.1%, p = 0.72) and minor (27.8% vs. 19.4%, p = 0.17) in-hospital complications were similar between the combined and control group, respectively. At 45 days, presence of peri-device leak (18.3% vs. 30.4%, p = 0.07) and device related thrombosis (4.5% vs. 4.5%, p = 0.96) on transesophageal echocardiogram did not differ. Finally, all-cause mortality (0% vs. 1.4%, p = 0.99), thromboembolic (0% vs. 0%, p = 0.99) and bleeding (6.1% vs. 4.4%, p = 0.73) events during follow-up were comparable.

Conclusion: This large, real-world analysis indicates comparable safety and efficiency of combined LAAO and CA when compared with LAAO alone.

Keywords: atrial fibrillation; catheter ablation; combined procedure; left atrial appendage occlusion; pulmonary vein isolation.

MeSH terms

Action Potentials
Aged
Aged, 80 and over
Atrial Appendage* / physiopathology
Atrial Appendage* / surgery
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / physiopathology
Atrial Fibrillation* / surgery
Atrial Function, Left
Cardiac Catheterization / adverse effects
Cardiac Catheterization / instrumentation
Catheter Ablation* / adverse effects
Combined Modality Therapy
Female
Heart Rate
Humans
Male
Middle Aged
Propensity Score*
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome