Prior Stroke Increases Residual Shunt Risk After Combined Ablation and LAAO: A Device-Specific Interaction.

BACKGROUND

The safety and efficacy profile of the combined "one-stop" catheter ablation (CA) and left atrial appendage occlusion (LAAO) procedure in atrial fibrillation (AF) patients with a prior history of cerebral infarction requires further validation.

METHODS

In this retrospective, single-center study, 242 consecutive AF patients undergoing the one-stop procedure were categorized into Stroke (n = 103) and Non-Stroke (n = 139) groups. A 1:1 propensity score matching (PSM) was performed, yielding 57 balanced pairs. The primary efficacy endpoint was procedural success. Key safety endpoints included post-procedural residual shunt assessed at 45 days, device-related thrombosis (DRT), and stroke recurrence.

RESULTS

After PSM, baseline characteristics were well-balanced. Procedural success (91.2% vs. 87.7%, p = 0.484) and freedom from AF recurrence (88.6% vs. 89.3%, p = 0.979) were comparable between Stroke and Non-Stroke groups. However, the incidence of residual shunt was significantly higher in the Stroke group (5.3% vs. 0%, p = 0.028). No significant differences were observed in DRT or stroke recurrence rates. Notably, a significant interaction was found between prior stroke and LAAO device type on residual shunt risk (p-for-interaction = 0.045), indicating the risk varied substantially depending on the occluder used.

CONCLUSION

A history of prior stroke does not impair the procedural success or mid-term rhythm control of the one-stop CA+LAAO strategy. However, it is associated with an increased risk of residual shunt, a relationship significantly modified by the type of occluder device. These findings highlight the potential need for individualized device selection in stroke survivors.