Abstract 14511: A Single Center Experience With the Safety and Feasibility of Concomitant Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion: Six-Month Outcomes

Abstract

Introduction: Given the procedural similarities between atrial fibrillation (AF) catheter ablation and left atrial appendage (LAA) occlusion, interest has grown over recent years in combining them into a single concomitant procedure as a strategy for rhythm control and stroke prevention. We report on the short-term outcomes of the combined procedure in a single center case series. Methods and Results Data was gathered by retrospective chart review. Between June 2015 to August 2021, 242 patients (61% male, mean age 72 ± 8, CHA2DS2-VASc 3.8 ± 1.3, HAS-BLED 2.5 ± 1.1) underwent concomitant AF ablation and LAA occlusion with the Watchman device. Successful occlusion occurred in 224 patients (93%) with a mean procedural time of 182 ± 76 minutes, mean maximum compression of 25 ± 5.5%, and a median number of 1 device. Reasons for aborting included anatomic difficulties (83%), the presence of sludge or thrombus in the LAA (11%), and edema at the site of ablation in only 1 case (6%). Peri-procedural complications included 2 cases of left atrial appendage perforation requiring surgical device extraction, 1 stroke, 6 cases of pericarditis, and 4 vascular access site complications including 1 retroperitoneal bleed, 1 superficial hematoma, 1 persistent bleeding requiring admission, and 1 arteriovenous fistula. 205 patients (92%) had appropriate follow-up within 6 months. Anticoagulation was successfully discontinued in 90 patients (44%) at 3 months, and 178 patients (87%) at 6 months. Antiarrhythmics were discontinued in 25 patients at 3 months (12%) and 35 patients at 6 months (17%). Ninety-day complications included 12 cases of gastrointestinal bleeding, 4 cases of genitourinary bleeding, 3 cases of volume overload, 2 cases of epistaxis, and 1 intracerebral hemorrhage. All patients with repeat imaging (95%) over a mean follow-up duration of 93 days remained with adequate occlusion, with 5 cases of device thrombosis (2%). Conclusion In conclusion, the combined procedures of catheter ablation for AF and LAA occlusion with the Watchman device appears to be safe and feasible. Further data are needed on long-term outcomes of arrhythmia recurrence, bleeding, and thromboembolic events to determine which patients might benefit most from the hybrid approach.