Cryoablation Combined with Left Atrial Appendage Closure: A Safe and Effective Procedure for Paroxysmal Atrial Fibrillation Patients

Abstract

Background. Catheter ablation combined with left atrial appendage closure (LAAC) was reported as a feasible strategy for atrial fibrillation (AF) patients with high risk of stroke or contraindications of oral anticoagulants. We aimed to observe the short-term safety and efficacy of combining cryoballoon ablation (CBA) with LAAC in paroxysmal (PAF) patients. Method and Results. From Jan 2016 to Dec 2017, 304 patients diagnosed with nonvalvular, drug-refractory PAF were included, who underwent either CBA alone (n = 262) or combined procedure (n = 42). Instant pulmonary vein isolation (PVI) with CBA was achieved in all patients, while successful LAAC achieved in 41 (97.6%) of combined procedure patients. 1-year freedom of AF rate was lower in combined procedure group (84.7% vs 70.7%, p=0.04), with unadjusted hazard ratio (HR = 1.97) and 95% confidence interval (CI) 1.03–3.77. However, the multivariate COX model revealed left atrial diameter (p=0.002, HR = 1.10, and 95% CI 1.04, 1.17), rather than procedure type (p=0.51, HR = 1.34, and 95% CI 0.57, 3.17), was the predictor for freedom of AF. Only 2 patients in the CBA group had stroke, contributing to the nonsignificant higher stroke incidence (p=1.00). Transoesophageal echochardiography (TEE) achieved in 35 patients (83.3%) showed complete occlusion with no obvious residual flow (>3 mm), Device-related thrombosis, or pericardial perfusion. All-cause mortality, rehospitalization, and complication rates were similar. Conclusion. Combining CBA with LAAC in a single procedure is a feasible strategy for PAF patients, with comparable short-term safety and efficacy to CBA alone.

Effect of catheter ablation combined with left appendage occlusion for non-valvular atrial fibrillation: a meta-analysis

“…After removing duplicated articles, 630 articles remained. Finally, after reading the full texts, a total of 18 studies were enrolled [ 7 – 10 , 13 – 26 ], including 1385 participants. The flow chart of literature screening was shown in Fig.…”

Acute left atrial ridge lesion after cryoballoon ablation: How does this affect left atrial appendage closure combined procedure?

“…Moreover, Fassini et al 17 were the first to report comparable results of the combined procedure, utilizing only CB for ablation in 35 AF patients. Thenceforth, several studies have provided further evidence to support the feasibility of the CB ablation combined procedure, 7,12 showing comparable clinical outcomes with the RF combined procedure 4–6 . The CB ablation combined procedure forms a novel approach for AF management.…”

“…The entire procedure was performed under local anesthesia using lidocaine. Procedure details followed the descriptions from previous literature 12 . Briefly, following the transseptal puncture, a 28‐mm second‐generation cryoballoon (CB; Arctic Front; Medtronic, MN, USA) was cannulated to the ostium of the PV.…”

The long‐term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and meta‐analysis

“…The flowchart of the study selection process was shown in Figure 1. In total, 16 studies were included, 13,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and one of the studies was divided into two arms for meta-analysis according to the procedural strategies (First LAAC then RFA or First FRA then LAAC), 35…”