Combined catheter ablation for atrial fibrillation and Watchman® left atrial appendage occlusion procedures: Five-year experience.
BACKGROUND
Patients with atrial fibrillation (AF) may benefit from undergoing concomitant interventions of left atrial catheter ablation and device occlusion of the left atrial appendage (LAA) as a two-pronged strategy for rhythm control and stroke prevention. We report on the outcome of combined procedures in a single center case series over a 5-year timeframe.


METHODS
Ninety-eight patients with non-valvular AF and a mean CHA2DS2-VASc score 2.6±1.0 underwent either first time, or redo pulmonary vein isolation (PVI) procedures, followed by successful implant of a Watchman® device.


RESULTS
All procedures were generally uncomplicated with a mean case time of 213±40 min. Complete LAA occlusion was achieved at initial implant in 92 (94%) patients. Satisfactory LAA occlusion was achieved in 100% of patients at 12 months, with a complete LAA occlusion rate of 86%. All patients discontinued oral anticoagulation. Persistent late peri-device leaks were more frequently associated with device angulation or shoulder protrusion, and were associated with a significantly lower achieved device compression of 12±3% vs. 15±5% (p<0.01) than complete occlusion. One ischemic stroke was recorded over a mean follow-up time of 802±439 days. Twelve months׳ freedom from detectable AF was achieved in 77% of patients.


CONCLUSIONS
Combined procedures of catheter ablation for AF and Watchman® LAA implant appear to be feasible and safe, with excellent rates of LAA occlusion achieved and an observed stroke rate of 0.5% per year during mid-term follow-up. Incomplete occlusion was associated with lower achieved device compression and was more frequently associated with suboptimal device position.
HeartCare Partners, GenesisCare, Greenslopes Private Hospital, Newdegate St, Greenslopes, Brisbane, QLD 4120, Australia.
Karen P
KP
Phillips
HeartCare Partners, GenesisCare, Greenslopes Private Hospital, Newdegate St, Greenslopes, Brisbane, QLD 4120, Australia.
Daniel T
DT
Walker
HeartCare Partners, GenesisCare, Greenslopes Private Hospital, Newdegate St, Greenslopes, Brisbane, QLD 4120, Australia.
Julie A
JA
Humphries
Atrial fibrillation; Catheter ablation; Device occlusion; Left atrial appendage; Watchman