Safety and feasibility of combined atrial fibrillation ablation and left atrial appendage occlusion after left atrial appendage electrical isolation

摘要

Objective To demonstrate the feasibility of combining left atrial appendage electrical isolation (LAAEI) with left atrial appendage occlusion (LAAO) to increase efficacy of persistent/longstanding atrial fibrillation (PLAF) catheter ablation (CA) while mitigating risk of left atrial appendage (LAA) thrombus. Background CA for atrial fibrillation (AF) plus LAAO is safe and feasible. LAAEI may improve freedom from recurrence in PLAF but may increase LAA thrombus. Methods We performed 42 concomitant procedures in patients with PLAF. After standard lesions, LAAEI was performed. LAAO immediately followed ablation. If 3-month transesophageal echocardiogram (TEE) was benign, oral anticoagulation (OAC) was transitioned to dual antiplatelet therapy for 3 more months. Results Patients were 71.1 +/- 8.5 years old, with CHADS2-VASc of 3.3 +/- 1.1 and HAS-BLED of 2.5 +/- 1.4. Twenty-eight of 42 patients (66.7%) were completely AF free over an average follow-up of 18.6 +/- 8.6 months. The AF-free survival estimate was 94.5% at 1 year. There was no thromboembolism (TE) during the follow-up. There were six non-significant leaks acutely and six non-significant leaks at 6 months. There were three device-related thrombi, although 2/3 stopped OAC prematurely. Conclusion A combined procedure is feasible and effective in treating arrhythmia and stroke risk associated with PLAF. The risk of TE despite OAC after LAAEI supports simultaneous LAAO.