Optimal combination strategy of left atrial appendage closure plus catheter ablation in a single procedure in patients with nonvalvular atrial fibrillation

BackgroundThe efficacy and safety of combining left atrial appendage closure (LAAC) plus atrial fibrillation (AF) catheter ablation (CA) in a single procedure has been established, but the optimal combination strategy has not been thoroughly elucidated to date. ObjectiveWe aimed to investigate the impact of different combination strategies on clinical outcomes. MethodsEighty-two consecutive patients with symptomatic AF (mean CHA(2)DS(2)-VASc score 4.4 1.4, mean HAS-BLED score 3.5 1.0) were enrolled. LAAC with the Watchman device was performed either before (occlusion-first group, N=52) or after (ablation-first group, N=30) CA. Procedural and clinical data were retrospectively analyzed to evaluate the advantages of each strategy. ResultsComplete device occlusions were achieved in 92.3% and 90.0% of patients, respectively (P=0.719). Neither acute nor chronic peridevice leak greater than 5mm was detected. Oral anticoagulants were held in all patients, except two (one in each group) with asymptomatic device-related thrombi. AF-free success rates were comparable between groups with a mean follow-up of 11.2 +/- 7.3 months (75.0%vs. 70.0%, log-rank P=0.311). The new peridevice leak rate was significantly lower in the occlusion-first group (7.7%vs. 26.7%, P=0.019). Multivariate logistic regression demonstrated that the combination strategy was independently associated with the new peridevice leak (P=0.025, OR 13.3). ConclusionsBoth occlusion-first and ablation-first strategies were efficacious and safe as combined procedures in patients with nonvalvular AF; however, the occlusion-first strategy was associated with lower new peridevice leak rates at follow-up.