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Chen M, Sun J, Wang QS, Zhang PP, Li W, Zhang R, Mo BF, Yu YC, Cai X, Yang M, Lian XM, Zhao Y, Gong C, Yu Y, Liu B, Feng X, Lu Q, Li YG. Long-term outcome of combined catheter ablation and left atrial appendage closure in atrial fibrillation patients. Int J Cardiol 2022; 368:41-48. [PMID: 35952939 DOI: 10.1016/j.ijcard.2022.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/19/2022] [Accepted: 08/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The combined procedure of catheter ablation and left atrial appendage closure (LAAC) aims to simultaneously control the heart rhythm and reduce the risk of strokes in patients with atrial fibrillation (AF). The study aims to evaluate the procedural safety and long-term outcome of the combined procedure in a large patient cohort. METHODS Clinical data of AF patients who underwent the combined procedure was retrospectively analyzed. Procedural and imaging follow-up parameters were compared between the transesophageal echocardiography-guided standard process and fluoroscopy-guided modified process, and between the single-seal WATCHMAN and dual-seal LACBES devices. Long-term outcomes included all-cause mortality, thromboembolic events, major bleeding, and recurrence of atrial tachyarrhythmias. RESULTS A total of 1114 patients were included. The rates of procedure-related major complications were comparable between the standard and modified processes (3.7% vs. 2.2%, p = 0.219), except for a higher incidence of respiratory depression in standard process group (0.9% vs 0%, p = 0.037), and between WATCHMAN and LACBES devices (2.4% vs. 3.3%, p = 0.535). The follow-up imaging evaluation revealed a high rate of satisfactory seals (99.7%) and a low rate of device related thrombus (1.9%), which were similar between two process groups and devices. The follow-up of over 1960 patient-years revealed low rates of mortality, thromboembolism, and nonprocedural major bleeding (1.8, 3.2, and 0.9 per 100 patient-years, respectively). Recurrent atrial tachyarrhythmias was observed in 23.9% patients. CONCLUSIONS The results supported the safety and long-term efficacy of the combined procedure of catheter ablation and LAAC. Fluoroscopy-guided LAAC device implantation may be considered in experienced centers.
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Affiliation(s)
- Mu Chen
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jian Sun
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Qun-Shan Wang
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Peng-Pai Zhang
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Wei Li
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Rui Zhang
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Bin-Feng Mo
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Yi-Chi Yu
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Xingxing Cai
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Mei Yang
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Xiao-Ming Lian
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Yan Zhao
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Changqi Gong
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Yi Yu
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Bo Liu
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Xiangfei Feng
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Qiufen Lu
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Yi-Gang Li
- Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China.
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