Efficacy and safety of concomitant catheter ablation and left atrial appendage closure compared to catheter ablation only - a meta-analysis.

BACKGROUND

Atrial fibrillation (AF) carries a substantial ischemic stroke risk originating predominantly from the left atrial appendage (LAA). Catheter ablation (CA) is the most effective rhythm-control strategy, while percutaneous LAA closure (LAAC) provides mechanical stroke prophylaxis. Combining both in a single one-stop procedure is increasingly performed, yet data on its rhythmic and periprocedural consequences remain scarce.

METHODS

We performed a systematic review and meta-analysis to compare the efficacy and safety of combined CA + LAAC versus CA-only in patients with AF. PubMed, Scopus and Web of Science were searched through June 12th 2026. The primary efficacy and safety outcomes were arrhythmia recurrence and periprocedural pericardial effusion requiring drainage, respectively. Binary endpoints were pooled as odds ratios (OR), continuous endpoints as mean differences (MD), using a random-effects model with heterogeneity reported as I2.

RESULTS

Fourteen studies comprising 3,274 patients (1,505 CA + LAAC; 1,769 CA-only) were included. Arrhythmia recurrence was significantly more frequent after combined CA + LAAC (OR = 1.56, 95% CI = 1.11-2.19, I2 = 47%). Systemic thromboembolism was numerically lower but did not differ significantly (OR = 0.66, 95% CI = 0.37-1.21, I2 = 0%). Total procedure time was significantly longer for the combined procedure (MD = + 9.34 min, 95% CI = 0.63-18.05, I2 = 90%). Periprocedural pericardial effusion requiring drainage did not differ between groups (OR = 1.19, 95% CI = 0.59-2.44, I2 = 0%).

CONCLUSION

Combined CA + LAAC was associated with significantly higher arrhythmia recurrence than CA-only, potentially attributable to limited substrate modification in the one-stop setting. The primary safety outcome, pericardial effusion requiring drainage, did not differ between groups. Randomised controlled trials are warranted to confirm these findings.