Combined catheter ablation and left atrial appendage closure as a hybrid procedure for the treatment of atrial fibrillation.
OBJECTIVE
Left atrial appendage (LAA) is the source of thrombi in up to 90% of patients with non-valvular atrial fibrillation (AF). Catheter ablation (CA) is an effective treatment for symptomatic AF and, in selected cases, LAA occlusion devices have been introduced as an alternative to oral anticoagulants (OACs). The safety and feasibility of combining CA and percutaneous LAA closure (LAAC) are unknown.


RESULTS
Patients with symptomatic drug-refractory AF, CHADS2 score of ≥1, and CHA2DS2-VASc score ≥2 were included. Catheter ablation consisted in pulmonary vein isolation with or without roof line with radiofrequency and LAA was occluded with the Watchman or Amplatzer Cardiac Plug (ACP) devices guided by angiography and transoesophageal echocardiography. A total of 35 patients were included (71% male; 70 years). Median score was 3 on both CHA2DS2-VASc and HAS-BLED, 9% had prior stroke under OAC, and 48% had bleeding complications. Successful CA and device implantation were achieved in 97% of cases. The Watchman device was used in 29 patients and ACP in 6 patients. Periprocedural complications included three cases of cardiac tamponade. At 3 months, all patients met the criteria for successful sealing of the LAA. After a mean follow-up of 13 months (3-75), 78% of patients were free of arrhythmia recurrences and OAC was withheld in 97% of patients.


CONCLUSIONS
The combination of CA and percutaneous LAAC in a single procedure is technically feasible in patients with symptomatic drug-refractory AF, high risk of stroke, and contraindications to OACs, although it is associated with a significant risk of major complications.
Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, University of Navarra, Av Pio XII, 36, 31008 Pamplona, Spain.
Naiara
N
Calvo
Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, University of Navarra, Av Pio XII, 36, 31008 Pamplona, Spain.
Nahikari
N
Salterain
Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, University of Navarra, Av Pio XII, 36, 31008 Pamplona, Spain.
Hugo
H
Arguedas
Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, University of Navarra, Av Pio XII, 36, 31008 Pamplona, Spain.
Alfonso
A
Macias
Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, University of Navarra, Av Pio XII, 36, 31008 Pamplona, Spain.
Alberto
A
Esteban
Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, University of Navarra, Av Pio XII, 36, 31008 Pamplona, Spain.
Manuel
M
García de Yébenes
Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, University of Navarra, Av Pio XII, 36, 31008 Pamplona, Spain.
Juan J
JJ
Gavira
Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, University of Navarra, Av Pio XII, 36, 31008 Pamplona, Spain.
Joaquín
J
Barba
Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, University of Navarra, Av Pio XII, 36, 31008 Pamplona, Spain igarciab@unav.es.
Ignacio
I
García-Bolao
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D055989:Septal Occluder Device; D016896:Treatment Outcome
D000925:Anticoagulants
Atrial fibrillation; Catheter ablation; Left atrial appendage closure; Oral anticoagulation