Long-Term Safety and Feasibility of Delayed Left Atrial Appendage Closure After Catheter Ablation

Background: This study aimed at comparing the safety and long-term outcomes pertaining to delayed left atrial appendage closure (LAAC) after catheter ablation (CA).Methods: The retrospective analysis in the study included 474 patients who received LAAC at our center between July 2017 and April 2024. Procedure- and device-related complications, major adverse events (MAEs), and recurrence of atrial fibrillation (AF) were compared among the CA + LAAC, Delayed-LAAC, and LAAC-only groups.Results: The Delayed-LAAC group did not report device-related thrombus (DRT) formation, and the CA + LAAC group presented obviously lower DRT incidence versus the LAAC-only group (0.7% vs. 7.1%, p = 0.02). Both CA + LAAC and Delayed-LAAC groups exhibited obviously lower stroke events rate versus the LAAC-only group (4.6% and 2% vs. 13.7%, p = 0.02). And all three groups demonstrated low rates of bleeding events (9.8% and 6% vs. 3.4%, p = 0.25) and all-cause death (1.9% and 2% vs. 5.2%, p = 0.23). The Delayed-LAAC group showed dramatically lower AF recurrence rate relative to the CA + LAAC group (16% vs. 35.2%, p = 0.006). In the multivariate Cox regression analysis, delayed LAAC (hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.20-0.93, and p = 0.03) and paroxysmal AF (HR = 0.56, 95% CI: 0.38-0.83, and p = 0.003) were protective factors. Patients with persistent AF and who once had been diagnosed with coronary heart disease (HR = 1.56, 95% CI: 1.11-2.21, and p = 0.01) were more likely to experience AF recurrence. Further subgroup analysis showed similar results.Conclusions: The Delayed-LAAC is as safe and feasible as the combination procedure. However, Delayed-LAAC was associated with lower AF recurrence rate.