Heart rhythm · 2026
Concomitant vs sequential atrial fibrillation ablation and left atrial appendage occlusion.
СтатьяНазвание и аннотация: Перевод в очереди
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Freeman James V, Kayser Susan A, Jacobsen Caroline M, Wang Danyang, Potukuchi Praveen Kumar, Piccini Jonathan P, Friedman Daniel J, Sutton Brad S
Аннотация
BACKGROUND: Increasingly, patients with atrial fibrillation meet the indications for rhythm control with catheter ablation and stroke prevention with left atrial appendage occlusion (LAAO).
OBJECTIVE: To assess the frequency of both procedures and compare the in-hospital safety of concomitant catheter ablation plus LAAO with the cumulative patient-level risk across sequential procedures.
METHODS: A retrospective analysis of Medicare fee-for-service beneficiaries with index LAAO (January 1, 2017-June 30, 2024) was conducted. Beneficiaries were classified as LAAO only, sequential ablation and LAAO (± 6 months), or concomitant. Procedure utilization and in-hospital outcomes were evaluated. For the sequential cohort, events from both encounters were combined to reflect the cumulative patient-level procedural risk. Inverse probability weighted logistic regression was used to compare stroke, major bleeding, and complications between groups.
RESULTS: Among 182,582 LAAO recipients, 20.9% underwent ablation during the study period; 7.7% within ± 6 months, including 1.5% concomitantly. Concomitant and sequential patients were clinically similar; LAAO-only patients were older and had more comorbidities. After adjustment, in-hospital stroke and pericardial effusion did not differ. Major bleeding was approximately 50% lower with concomitant procedures (adjusted odds ratio [aOR], 0.54; 95% CI, 0.42-0.69; P < .01). Vascular complications were also lower (aOR, 0.67; 95% CI, 0.47-0.94; P = .02).
CONCLUSION: Concomitant ablation and LAAO demonstrated comparable in-hospital stroke and pericardial effusion risks, but lower observed risks of bleeding and vascular complications compared to the cumulative risk across sequential procedures, supporting a single-session approach when clinically appropriate.
OBJECTIVE: To assess the frequency of both procedures and compare the in-hospital safety of concomitant catheter ablation plus LAAO with the cumulative patient-level risk across sequential procedures.
METHODS: A retrospective analysis of Medicare fee-for-service beneficiaries with index LAAO (January 1, 2017-June 30, 2024) was conducted. Beneficiaries were classified as LAAO only, sequential ablation and LAAO (± 6 months), or concomitant. Procedure utilization and in-hospital outcomes were evaluated. For the sequential cohort, events from both encounters were combined to reflect the cumulative patient-level procedural risk. Inverse probability weighted logistic regression was used to compare stroke, major bleeding, and complications between groups.
RESULTS: Among 182,582 LAAO recipients, 20.9% underwent ablation during the study period; 7.7% within ± 6 months, including 1.5% concomitantly. Concomitant and sequential patients were clinically similar; LAAO-only patients were older and had more comorbidities. After adjustment, in-hospital stroke and pericardial effusion did not differ. Major bleeding was approximately 50% lower with concomitant procedures (adjusted odds ratio [aOR], 0.54; 95% CI, 0.42-0.69; P < .01). Vascular complications were also lower (aOR, 0.67; 95% CI, 0.47-0.94; P = .02).
CONCLUSION: Concomitant ablation and LAAO demonstrated comparable in-hospital stroke and pericardial effusion risks, but lower observed risks of bleeding and vascular complications compared to the cumulative risk across sequential procedures, supporting a single-session approach when clinically appropriate.