Combined left atrial appendage occlusion and catheter ablation for atrial fibrillation versus isolated left atrial appendage occlusion: A systematic review and meta-analysis.

Abstract

Background: Data on the effects of combined left atrial appendage occlusion (LAAO) and catheter ablation (CA) for atrial fibrillation (AF) remain limited. We aimed to perform a systematic review and meta-analysis comparing LAAO and CA versus isolated LAAO.

Methods: We systematically searched PubMed, Embase, and Cochrane Library for studies comparing combined LAAO and CA versus isolated LAAO in patients with atrial fibrillation. Statistical analyses were performed using R software version 4.3.1. We pooled odds ratios (OR) with 95 % confidence intervals (CI) for binary outcomes.

Results: We included eight studies comprising 51,802 patients, of whom 1375 (2.6 %) underwent combined LAAO and CA. There were no significant differences between combined LAAO and CA versus isolated LAAO in terms of major bleeding (OR 0.55; 95 % CI 0.09, 3.41; p = 0.52; I² = 0 %), major adverse cardiovascular events (OR 0.88; 95 % CI 0.40, 1.93; p = 0.74; I² = 0 %), stroke (OR 1.03; 95 % CI 0.35, 3.00; p = 0.96; I² = 0 %), thromboembolism (OR 0.60; 95 % CI 0.18, 1.98; p = 0.40; I² = 0 %), minor bleeding (OR 1.32; 95 % CI 0.63, 2.80; p = 0.46; I² = 0 %), or pericardial effusion (OR 1.18; 95 % CI 0.60, 2.33; p = 0.63; I² = 24 %).

Conclusion: In this meta-analysis of observational studies, combined LAAO and CA for AF was similar to isolated LAAO in terms of efficacy and safety. Further large randomized controlled trials are needed to explore the long-term effects of combining these procedures.