Efficacy and safety of catheter ablation combined with left atrial appendage occlusion for nonvalvular atrial fibrillation: A systematic review and meta‐analysis

Abstract

Atrial fibrillation (AF) is currently the most prevalent arrhythmia in clinical practice, with stroke being one of its major complications. Combining catheter ablation and percutaneous left atrial appendage occlusion (LAAO) into a "one-stop" intervention could reduce stroke incidence in selected high-risk patients and, at the same time, relieve AF symptoms in a single procedure.This meta-analysis analyzed the efficacy and safety of catheter ablation combined with LAAO for nonvalvular AF. PubMed, EMBASE, and the Cochrane Library were searched from inception to April 2019 to identify relevant citations. Efficacy indexes were procedural success, AF recurrence, stroke/transient ischemic attacks (TIA), and device-related thrombus (DRT). Safety indexes were all-cause death, major hemorrhagic complications, and pericardial effusion/cardiac tamponade. The incidence rate of events (ratio of events to patients) and 95% confidence interval (CI) were calculated as summary results. A forest plot was constructed to present pooled rates. Eighteen studies (two randomized controlled trials and 16 observational studies) were included. The results showed that one-stop intervention has significant efficacy and safety, with procedural success of .98 (95% CI, .97-1.00), AF recurrence of .24 (95% CI, .15-.35), stroke/TIA of .01 (95% CI, .00-.01), DRT of .00 (95% CI, .00-.01), all-cause mortality of .00 (95% CI, .00-.00), cardiac/neurological mortality of .00 (95% CI, .00-.00), major hemorrhagic complications of .01 (95% CI, .00-.02), and pericardial effusion/cardiac tamponade of .01 (95% CI, .00-.01). A single procedure with catheter ablation and LAAO in AF is a feasible strategy with significant efficacy and safety. K E Y W O R D Satrial fibrillation, catheter ablation, left atrial appendage occlusion, stroke prevention

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

“…The pooled rates of device embolization and other bleeding events were as low as 0.01, and the average annualized bleeding rate reduction was as high as 60.3%. The results of the long-term adverse events were likely to previous studies, 15,16 indicating this combined procedure had a reliable performance on safety.…”

“…In the case of efficacy outcomes, the results showed the combined procedure had a high rate of 1.00 in long-term successful sealing of LAAC, similar to recent meta-analysis results with a successful sealing rate of 0.98. 16 The pooled rate of ischemic stroke/TIA/systemic embolism during follow-up was as low as 0.01. Importantly, the average annualized stroke rate reduction was as high as 79.7%.…”

“…13,14 Additionally, meta-analyses revealed the short-term efficacy and safety of the combined procedure for AF patients with high stroke risk. 15,16 Despite the promising results, the limitation of previous studies should be highlighted, including a small sample size (e.g., less than ten patients), [17][18][19] lack of long-term follow-up (e.g., less than 6 months), [20][21][22] and noncombined ablation and LAAC. 23,24 In this study, we evaluated the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety of the combination of ablation and LAAC.…”

Combination of ablation and left atrial appendage closure as “One‐stop” procedure in the treatment of atrial fibrillation: Current status and future perspective

“…A recent study from China revealed that the immediate success rate of LAAC after CA was 100 percent 21 . What is more, a meta‐analysis of 18 studies showed that the one‐stop procedure had a 98% procedural success rate of LAAC 22 . Different success rate of device implantation in the combination procedure may be associated with patient volume and operator's experience.…”

Device-Related Thrombosis in Patients Receiving One-Stop Intervention for Nonvalvular Atrial Fibrillation: A Systemic Review and Meta-Analysis

“…Recently, Jiang et al conducted a meta-analysis on the efficacy and safety of CA combined with LAAO, concluding that a single procedure combining these 2 approaches is a feasible strategy with significant levels of efficacy and safety. 3 Therefore, one-stop intervention may become increasingly common in clinical practice in the future.…”