Safety and Outcomes of Concomitant Left Atrial Appendage Occlusion and Atrial Fibrillation Ablation.

BACKGROUND

Performing atrial fibrillation (AF) catheter ablation and percutaneous left atrial appendage occlusion (LAAO) during a single procedure may improve efficiency and reduce cumulative procedural risk. However, concerns remain regarding potential increases in periprocedural and longer-term complications, including stroke, pericardial effusion, device leak, and device-related thrombus. Evidence evaluating the safety of this concomitant strategy remains limited.

OBJECTIVES

The objectives of the study was to compare the safety and short- and long-term outcomes of concomitant AF ablation plus LAAO vs LAAO alone.

METHODS

We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network, identifying adults (≥18 years) with AF who underwent percutaneous LAAO between January 2015 and February 2026. Patients undergoing AF ablation on the same day as LAAO were compared with those undergoing LAAO alone. After 1:1 propensity score matching for demographics, comorbidities, cardiovascular medications, and laboratory values, 1,899 patients were included in each group. Outcomes including all-cause mortality, stroke, device leak, device-related thrombus, pericardial effusion, and pericardiocentesis were assessed at 7 days, 90 days, and 1 year using cumulative incidence and Cox proportional hazards models.

RESULTS

Baseline characteristics were well balanced after matching. Concomitant AF ablation was not associated with increased adverse events. Mortality was similar at 90 days (0.6% vs 0.6%; HR: 1.00; 95% CI: 0.43-2.32) and 1 year (1.4% vs 1.5%; HR: 0.97; 95% CI: 0.58-1.63). At 90 days, rates of stroke, device leak, and device-related thrombus were comparable between groups, with no differences observed at 1 year.

CONCLUSIONS

In this large, propensity-matched analysis, concomitant AF ablation at the time of LAAO was not associated with increased early or 1-year complications, supporting the safety of a combined approach in appropriately selected patients.