Efficacy and Safety of Catheter Ablation Combined with Left Atrial Appendage Closure in the Treatment of Atrial Fibrillation: A Systematic Review and Meta-Analysis

Background: Catheter ablation combined with left atrial appendage closure is effective in treating atrial fibrillation. However, the effectiveness of this combined treatment compared with catheter ablation alone is still controversial. Methods: We searched studies in databases, including The Cochrane Library, PubMed, EMBASE, and Web of Science, that compared catheter ablation combined with left atrial appendage closure and catheter ablation alone in the treatment of atrial fibrillation. These studies reported at least one of the following outcomes: the freedom from atrial arrhythmia rate, the procedure time, the fluoroscopy time, perioperative complications, thromboembolic events, and bleeding events during follow-up. The risk ratio and standard mean difference with 95% CI were analyzed by the random-effects model. Results: Five studies involving 699 people were included in our meta-analysis. We found no significant difference in the freedom from atrial arrhythmia rate (risk ratio =0.93, 95% CI =0.83-1.04, I-2=0%, P= .21) between the 2 groups. Catheter ablation combined with left atrial appendage closure showed significantly longer procedure and fluoroscopy times than catheter ablation alone (standard mean difference =1.26, 95% CI =0.85-1.67, P < .00001 and standard mean difference=1.19, 95% CI =0.53-1.85, P= .0004, respectively). With regard to safety outcomes, no significant differences were observed in perioperative complications (RR =1.62, 95% C1=0.99-2.63, I-2 =0%, P= .05), thromboembolic events (RR = 0.67, 95% CI = 0.15-3.11, I-2=0%, P= .61), or bleeding events (RR = 0.67, 95% CI =0.11-3.88, P= .65) between the 2 groups during follow-up. Conclusion: The freedom from atrial arrhythmia rate and safety outcomes of catheter ablation combined with left atrial appendage closure are similar to those of catheter ablation alone. Catheter ablation combined with left atrial appendage closure appears to have longer procedure and fluoroscopy times than catheter ablation alone.