Journal of the Society for Cardiovascular Angiography & Interventions · 2026
Combined Direct Current Cardioversion and Left Atrial Appendage Occlusion in Patients With Contraindication to Anticoagulation: A Single-Center Feasibility Study.
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Chen Lawrence, Pham Tai, Aman Edris, Khong Anthony, Munir Irsa, Dong Tiffany, Munir Muhammad B, Smith Thomas W R, Rogers Jason H, Singh Gagan
Аннотация
BACKGROUND: Direct current cardioversion (DCCV) for atrial fibrillation is typically followed by 3 to 4 weeks of oral anticoagulation (OAC) because of atrial stunning and thromboembolic risk, which some patients cannot tolerate. Left atrial appendage occlusion (LAAO) provides an OAC-sparing alternative, but the feasibility of performing DCCV immediately before LAAO has not been well defined.
METHODS: We conducted a retrospective single-center study of consecutive patients with atrial fibrillation with relative or absolute contraindications to post-cardioversion OAC who underwent planned DCCV immediately followed by percutaneous LAAO using Watchman FLX or FLX Pro devices. Procedural characteristics, in-hospital outcomes, follow-up imaging findings, and clinical outcomes at 45 days, 3 months, and 1 year were assessed using cardiac computed tomography or transesophageal echocardiography.
RESULTS: Twelve patients underwent concomitant DCCV + LAAO (mean age 75 ± 9 years; 33% women). Bleeding history was present in 67%, with mean CHA2DS2-VASc and HAS-BLED scores of 3.7 ± 1.1 and 2.1 ± 0.7, respectively. Acute DCCV success was achieved in 11 patients (92%), and LAAO technical success was 100%. Mean procedure time was 48 ± 15 minutes. Follow-up imaging was completed in 12 patients and identified 1 low-risk device-related thrombus (9%), peri-device leak >3 mm in 18%, and no leaks >5 mm. At 45 days and 3 months, there were no deaths, strokes, systemic embolic events, or major bleeding events. At 1 year (n = 7), 1 cardiovascular death occurred without thromboembolic or major bleeding complications.
CONCLUSIONS: In this pilot series, a combined DCCV + LAAO strategy was feasible and not associated with excess thromboembolic or bleeding events. Early and intermediate outcomes were comparable to contemporary standalone LAAO experience. Larger prospective studies are needed to further evaluate this OAC-sparing approach.
METHODS: We conducted a retrospective single-center study of consecutive patients with atrial fibrillation with relative or absolute contraindications to post-cardioversion OAC who underwent planned DCCV immediately followed by percutaneous LAAO using Watchman FLX or FLX Pro devices. Procedural characteristics, in-hospital outcomes, follow-up imaging findings, and clinical outcomes at 45 days, 3 months, and 1 year were assessed using cardiac computed tomography or transesophageal echocardiography.
RESULTS: Twelve patients underwent concomitant DCCV + LAAO (mean age 75 ± 9 years; 33% women). Bleeding history was present in 67%, with mean CHA2DS2-VASc and HAS-BLED scores of 3.7 ± 1.1 and 2.1 ± 0.7, respectively. Acute DCCV success was achieved in 11 patients (92%), and LAAO technical success was 100%. Mean procedure time was 48 ± 15 minutes. Follow-up imaging was completed in 12 patients and identified 1 low-risk device-related thrombus (9%), peri-device leak >3 mm in 18%, and no leaks >5 mm. At 45 days and 3 months, there were no deaths, strokes, systemic embolic events, or major bleeding events. At 1 year (n = 7), 1 cardiovascular death occurred without thromboembolic or major bleeding complications.
CONCLUSIONS: In this pilot series, a combined DCCV + LAAO strategy was feasible and not associated with excess thromboembolic or bleeding events. Early and intermediate outcomes were comparable to contemporary standalone LAAO experience. Larger prospective studies are needed to further evaluate this OAC-sparing approach.