A procedure combining catheter ablation (CA) and left atrial appendage closure (LAAC) for the treatment of atrial fibrillation (AF) was found to be safe and efficacious, according to a single-center retrospective, case-control study published in the Journal of Interventional Cardiology.
Patients fitting 2 of the 3 following criteria were eligible for the study: CHA2DS2-VASc score ≥2 and HAS-BLED score ≥3; chronic oral anticoagulation (COA) intolerance; and stroke/transient ischemic attack or thromboembolism (TE) despite treatment with COA. Patients underwent CA (n=549), LAAC (n=142), or CA and LAAC combined (n=76) at Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China between 2017 and 2018. The patient cohorts were balanced using propensity scores and a total of 228 patients were included in the final analysis (n=76 in each treatment group).
Before propensity score matching, several baseline characteristics of patients who underwent the combined procedure vs differed significantly; these included, when compared with CA alone: age (P <.001), heart failure (P <.001), previous stroke (P <.001), left atrial diameter (P <.001), CHA2DS2-VASc score (P <.001), HAS-BLED score (P <.001), paroxysmal atrial fibrillation (P =.019), and persistent atrial fibrillation (P =.019); and when compared with LAAC alone: paroxysmal atrial fibrillation (P <.001), persistent atrial fibrillation (P <.001), age (P =.019), and previous stroke (P =.023).
Complications due to the combined procedure included 2 groin hematomas and 1 pericardial effusion. Among patients in the CA group, 1 groin hematoma and 1 pericardial effusion were observed. Among the LAAC cohort, 1 patient had a groin hematoma and 1 had a transient coronary air embolism.
Pulmonary vein isolation was conducted in 51.3% and 53.9% of patients who underwent the combined procedure and CA only, respectively (P =.745). The procedure (129±24.5 min vs 133.1±26.4 min) and fluoroscopy (5.4±2.4 min vs 5.9±2.6 min) durations were similar for the combined and CA groups, respectively. At follow-up (mean, 24 months), comparable percentage of patients who underwent the combined procedure and CA only (67.1% and 69.7%, respectively; P =.727) were atrial fibrillation-free of antiarrhythmic drugs, and rates of atrial fibrillation were similar (15.8% vs 11.8%, respectively) in both groups.
The device compression was comparable in the combined procedure and LAAC groups (19.6±4.5% vs 18.4±4.3%, respectively; P =.085). All patients had a residual leak ≤5 mm. Complete occlusion was achieved in 94.7% and 93.4% of patients in the combined procedure and LAAC only groups, respectively (P =.513). Duration of procedure (P =.149) and fluoroscopy (P =.273) were comparable in those 2 groups.
A major limitation of this study is its small sample size.
“The combination of AF-CA and LAAC is safe and efficacious compared with single procedures alone,” concluded the study authors. “Randomized control trials are needed to further verify the benefit of combined therapy in selected patients with AF.”
Mo B F, Sun J, Zhang P P, et al. Combined Therapy of Catheter Ablation and Left Atrial Appendage Closure for Patients with Atrial Fibrillation: A Case-Control Study. J Interv Cardiol. 2020;8615410. doi:10.1155/2020/8615410