Catheter Ablation In Combination With Left Atrial Appendageclosure 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. Meanwhile, left atrial appendage closure(LAAC) is an effective treatment to prevent stroke for AF. The safety and feasibility of combining CA and percutaneous LAAC are unknown.Methods:Twenty-six patients with non-valvular AF and a mean CHA2DS2-VASc score 3.5±1.6 underwent either first time of pulmonary vein isolation (PVI) procedures, followed by successful implant of a Watchman device.Results:26 patients were treated (10 female; age,64±10 years). Mean CHA2DS2-VASc score was 3.5±1.6 (range,2 to 7), mean HAS-BLED score was 2.4±1.1 (range,1 to 5), 42% had prior stroke. Total procedure time was 162.8±61.2 minutes (range,52 to 284 minutes). At 60 days, all patients met the criteria for successful sealing. All patients met the criteria for successful sealing of the LAA after the procedural with complete LAA occlusion in 22(84.6%). There was 4 new peri-device leaks after 3 months,but still met the criteria.Periprocedural complications included 2 cases of pericardial effusion. There was no obvious changes of the anatomical Structure of left atrium(LA)(4.3cm vs 4.3cm, p>0.05), but the ejection fraction (EF) was obvious increased (60.4% vs 66.9%, p <0.05).There was no death, stroke、device embolism、major bleeding happening in the follow-up visit, just 1 recurrence of AF.Conclusion:The combination of CA and percutaneous LAAC in a single procedure is feasible and safe for Chinese non-valve fibrillation patients. It can be an alternative therapeutic schedule for patients with symptomatic drug-refractory AF, high risk of stroke, and contraindications to oral anticoagulants (OACs).