Effectiveness and safety of one-stop procedure versus ablation alone in patients with non-valvular atrial fibrillation: a meta-analysis

Abstract

Background: Catheter ablation (CA) and left atrial appendage closure (LAAC) are two effective treatments for atrial fibrillation. Furthermore, atrial fibrillation (AF) ablation combined with left atrial occlusion closure (LAAC) is a potential therapy option for AF in individuals who are at high risk of stroke or who are unable to take oral anticoagulants. This study intends to analyze and evaluate the difference in effectiveness and safety between one-stop operation, in which patients accept AF ablation and LAAC in one surgery, and ablation alone in patients with non-valvular AF through the method of meta-analysis. Methods: This study searches PubMed, Embase, Medline, the Cochrane Library, CNKI, VIP Database, and WANFANG Database for clinical studies of combined therapy and AF ablation in the prevention of AF, combining subject words with free words, and the retrieval time is from the establishment of each database to September 29, 2021. Results: The meta-analysis comprised five clinical studies with a total of 488 patients with AF who received AF ablation alone and 269 patients who received ablation and LAAC in one stop. Patients with paroxysmal AF, persistent AF, long-standing persistent AF, or all of these conditions were included in all of the investigations. At long-term follow-up, the rate of AF recurrence was not substantially different between the two groups (one-stop procedure 39.03 % vs. AF ablation 28.28 %, respectively; OR 1.34; 95% CI 0.95-1.87; P = 0.32). Furthermore, there was no statistically significant difference in terms of major complications and adverse events between the two groups (one-stop procedure 13.75 % vs. AF ablation 13.73 %, respectively; OR 0.73; 95% CI 0.44-1.18; P = 0.54). Conclusion: Using LAAC in addition to CA had no effect on the efficacy of AF ablation, and the combination method was performed without an increased risk of acute procedural complications or negative effects.