Left atrial appendage closure after cryoballoon ablation in patients with atrial fibrillation

Background. Cryoballoon ablation (CBA) is effective for patients with drug-refractory symptomatic atrial fibrillation (AF). For patients with a high risk of stroke (CHA(2)DS(2)-VASc score >= 2), life-long oral anticoagulation therapy should be continued even after successful catheter ablation. We investigated the safety and efficacy of concomitant use of a second-generation CBA catheter for pulmonary vein isolation (PVI) and a left atrial appendage closure (LAAC) device in patients with AF. Methods. We enrolled 27 patients (64.7 +/- 6.3 years, 74% male, 63% paroxysmal AF, 37% persistent AF, 4.8 +/- 1.4 CHA(2)DS(2)-VASc score, and 3.6 +/- 1.3 HAS-BLED score). In total, 85% of the patients had a prior stroke or TIA, and 30% of patients had a clinical history of bleeding. Patients received a CBA for PVI and underwent occlusion of the LAA with an LAAC device. The efficacy of CBA was defined as lack of arrhythmia recurrence (AF, atrial flutter, and/or atrial tachycardia lasting >= 30 s) after a 90-day blanking period. The success of LAAC was determined by the rate of stroke, TIA, and/or bleeding events. Results. The mean procedural time for CBA and LAAC was 80 +/- 16 min and 44 +/- 12 min, respectively. Acute PVI by CBA was achieved in 100% of the procedures, and 96% of patients obtained acute LAAC device placementduring the procedure. Upon complete release of the LAAC device, only 62% patients (16/26) had no detectable leakage during intraprocedural transesophageal echocardiography. Three patients experienced an acute complication: a pericardial effusion and two phrenic nerve palsy events. Mean follow-up was 18 months (range 9-23 months), and freedom from AF recurrence was 74% (20/27). Conclusion. The intraprocedural combination of CBA and LAAC is feasible in patients with non-valvular AF with a high risk of stroke, TIA, and/or bleeding. Larger long-term randomized studies are needed to judge the overall safety and efficacy of the combined procedure.